The Health Care Workforce in New York, 2015-2016 Trends in the Supply and Demand for Health Workers

Home , Central New York Region, Mohawk Valley region

2016

School of Public Health University at Albany, State University of New York

The Health Care Workforce in New York, 2015-2016: Trends in the Supply of and Demand for Health Workers

February 2017

School of Public Health, University at Albany State University of New York 1 University Place, Suite 220 Rensselaer, NY 12144-3445 Phone: (518) 402-0250 Web: www.chwsny.org Email: [email protected]

PREFACE

This report summarizes data and information about New York’s health workforce to describe supply of and demand for workers and to provide projections for future demand. The goals of this report are to assist policy makers and other stakeholders to target health workforce education and job training resources to address the most pressing health care workforce needs; to guide health workforce policies, including decisions about the capacity of health professions education programs; and to inform current and prospective students about health care employment prospects and opportunities.

This report was prepared by Center for Health Workforce Studies (CHWS) staff, including Robert Martiniano, Lauren Boyd, Randy Rosario, Jenny Gao, Yuhao Liu, Nafin Harun, Shen Wang, and Jean Moore, with editing by Rachel Carter and Leanne Keough. Funding for this report was provided by the 1199 Hospital League Health Care Industry Planning and Placement Fund, Inc.

Established in 1996, CHWS is an academic research organization, based at the School of Public Health, University at Albany, State University of New York (SUNY). The mission of CHWS is to provide timely, accurate data and conduct policy relevant research about the health workforce. The research conducted by CHWS supports and promotes health workforce planning and policymaking at local, regional, state, and national levels. Today, CHWS has established itself as a national leader in the field of health workforce studies.

The views expressed in this report are those of CHWS and do not necessarily represent positions or policies of the School of Public Health, University at Albany, SUNY, the New York State Education Department, the New York State Department of Health, or 1199 Hospital League Health Care Industry Planning and Placement Fund, Inc.

February 2017

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ACKNOWLEDGEMENTS

Special appreciation is extended to the participating provider associations as well as the human resources staff who provided valuable information about health workforce recruitment and retention issues.

SUGGESTED CITATION

Martiniano R, Boyd L, Rosario R, Gao J, Liu Y, Harun N, Wang S, Moore J. The Health Care Workforce in New

York, 2015-2016: Trends in the Supply and Demand for Health Workers. Rensselaer, NY: Center for Health

Workforce Studies, School of Public Health, SUNY Albany; February 2017.

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Table of Contents I. EXECUTIVE SUMMARY ...... 4

A. BACKGROUND ...... 4 B. KEY FINDINGS ...... 5 II. BACKGROUND ...... 7

A. OVERVIEW ...... 7 B. OBJECTIVES AND GOALS ...... 8 C. DATA SOURCES AND METHODS...... 8 D. TERMINOLOGY ...... 12 E. GEOGRAPHIC AREAS ...... 13 III. THE HEALTH CARE WORKFORCE IN THE UNITED STATES ...... 15 A. Total Employment ...... 15 B. By Setting ...... 16 C. By Occupation...... 19 IV. NEW YORK HEALTH SECTOR EMPLOYMENT ...... 21

A. TOTAL EMPLOYMENT...... 21 B. HEALTH SECTOR EMPLOYMENT ...... 23 C. BY REGION ...... 24 1. Hospital Employment ...... 26 2. Ambulatory Care ...... 27 3. Nursing and Personal Care Facility Employment ...... 28 4. Home Health Care ...... 29 D. BY OCCUPATION ...... 29 E. PRIMARY CARE PHYSICIANS ...... 32 F. TRENDS IN NEW YORK RN EDUCATION, 2005-2016 ...... 35 G. DEMAND FOR WORKERS ...... 40 1. Hospitals ...... 41 2. Nursing Homes ...... 41 3. Home Health Care Agencies ...... 43 4. Federally Qualified Health Centers ...... 44 H. PROJECTED JOB GROWTH...... 45 V. REGIONAL PROFILES...... 46

A. NEW YORK CITY ...... 46 B. CAPITAL DISTRICT ...... 61 C. CENTRAL NEW YORK ...... 73 D. FINGER LAKES ...... 85 E. HUDSON VALLEY ...... 97 F. LONG ISLAND ...... 109 G. MOHAWK VALLEY...... 121 H. NORTH COUNTRY ...... 133 I. SOUTHERN TIER ...... 145 J. WESTERN NEW YORK ...... 157

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I. EXECUTIVE SUMMARY

A. Background

The health workforce is a cornerstone of the health care delivery system. Efforts to provide high-quality, accessible health care depend on the availability of an adequate supply of appropriately trained health workers. At a time when health care systems are undergoing dramatic changes, data and information on the health workforce can greatly contribute to informed decision making. The health care sector continues to grow in New York, accounting for about 12% of total employment, and continues to increase faster than employment in all other sectors. Additionally, many of the fastest growing occupations in the state are in the health sector. Despite this growth, there is still unmet demand for health care workers in many areas of the state.

New York has a longstanding commitment to population health, particularly for the underserved. Currently, one of New York’s most notable efforts to improve the health of its citizens fall under its Medicaid waiver program, the Delivery System Reform Incentive Payment Program (DSRIP), which has supported performing provider systems aimed at reducing the number of inappropriate hospitalizations and emergency department visits for Medicaid patients, particularly those with chronic diseases and multiple comorbidities. Another important initiative underway in New York is the State Health Information Plan (SHIP), designed to identify and stimulate the spread of promising innovations in health care delivery and finance that result in optimal health outcomes for all New Yorkers. As a result of these efforts, the state’s providers are strengthening their primary care infrastructure, integrating primary care with behavioral health, focusing on preventive services, and building the capacity for more effective management of chronic diseases.

There is growing emphasis on providing care that is better coordinated, with greater patient engagement and a better understanding of the impacts of social determinants of health on outcomes. Increasingly, providers are adopting team-based models of care that are changing the demand for health workers and the skills these workers need to effectively serve New Yorkers.

As employment in health care continues to grow, there are some differences by region and setting. Employment in home health care in New York is growing the fastest, followed by growth in ambulatory care. Employment in hospitals accounts for over 40% of health care sector employment, but has added fewer new jobs compared to other health care settings. Despite the overall growth in health care jobs in the state, there are still many areas with provider shortages. This report presents data drawn from a variety of sources to describe the state’s health workforce, and provides information statewide and by region. It includes information on the health status of New Yorkers, the health care system, and the supply of and demand for health workers. The report is designed to assist policy makers and other stakeholders to improve health workforce planning efforts.

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B. Key Findings Health sector employment in the state and the nation continues to be an important economic driver, accounting for a substantial amount of job growth. • In 2014, there were nearly 20 million jobs in the US either in the health sector or in health occupations employed outside the health sector, accounting for over 13% of the total US workforce. • Health sector employment in the state accounted for over 12% of total employment in 2014, higher than the national level of nearly 10%. • Health sector employment in New York has grown by nearly 24% between 2000 and 2014, compared with less than 1% job growth for all other employment sectors. • Between 2000 and 2014, upstatea New York saw rapid health sector job growth with a 17% increase; jobs outside of the health care sector declined by around 6% during that same period. • Regionally, health care employment varied across the state. Between 2010 and 2014, some upstate regions experienced job growth of almost 7%, while others experienced small declines. New York City experienced the largest job growth, increasing by more than 11% over the same 5- year period.

Statewide, jobs grew more rapidly in home health and ambulatory care between 2000 and 2014, compared to other health sector settings. • While hospitals continued to employ the largest share of health sector workers in the state, job growth was more pronounced in other health care settings. • Statewide health sector job growth by setting between 2000 and 2014 was as follows: o Hospitals (+27,025, 6.6%) o Ambulatory care (+73,870, 30.1%) o Nursing home and personal care facilities (+16,619, 11.6%) o Home health care (+87,656, 135.7%)

Changes in the number of health care jobs in New York between 2010 and 2014 varied by occupation. • The number of personal care aide jobs increased by nearly 40,700 or 40%. • The number of occupational therapist jobs increased by over 2,000 or 29%. • The number of physician assistant jobs increased by nearly 1,200 or by 29%. • The number of registered nursing jobs declined slightly by 150 or 0.1%. • The number of social worker jobs declined by nearly 1,500 or almost 3%.

Between 2010 and 2014, there was variable growth in the number of licensed health professionals by occupation in the state. • The number of licensed nurse practitioners grew by almost 30% to 19,825, and the number of licensed physician assistants grew by 31% to over 13,300. • The number of licensed occupational therapists grew by nearly 16% to almost 12,000, while the number of physical therapists rose by just over 9% to nearly 22,000.

a For purposes of this report, upstate New York is considered as all counties outside of New York City.

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• The number of registered nurses (RNs) grew by nearly 4% to over 280,230 while the number of licensed practical nurses (LPNs) increased by just over 4% to over 72,440.

Primary care physiciansb and psychiatristsc are not well distributed across the state, with wide regional variation. • In 2015, the New York City region had the most primary care physicians per capita with 89.6 per 100,000, while the Mohawk Valley (61.5 per 100,000) had the least. • The New York City region had the most psychiatrists per capita per capita (43.0 per 100,000) in 2015, while the Western New York and Mohawk Valley regions had the least (13.8 per 100,000 and 13.7 per 100,000, respectively).

In 2016, hospitals across the state reported the most difficulty recruiting experienced RNs, nurse practitioners (NPs), physician assistants (PAs) and clinical laboratory technologists. • Hospitals also indicated that while recruiting newly licensed RNs was not problematic, they were more difficult to retain. • Hospitals reported plans to expand both inpatient and outpatient services and anticipate a growing demand for NPs, care coordinators, and clinical laboratory technologists.

Nursing homes in the state reported the most difficulty recruiting and retaining RNs, LPNs, and certified nurse aides in 2016. • The majority of nursing homes reported difficulty hiring workers for evening, night, and weekend shifts. • About 15% of nursing homes projected expansion of services within the next year, with the remaining nursing homes indicating they would stay the same.

In 2016, the state’s home health agencies reported the greatest difficulty recruiting speech- language pathologists, occupational therapists, experienced RNs, and respiratory therapists. • While home health agencies indicated some difficulty recruiting home health aides, homemakers, and personal care aides, they reported greater difficulty retaining them. • Fifty-two percent of home health care agencies projected service expansion, while most of the remainder expected to keep services at the same level.

Federally qualified health centers (FQHCs) in the state in 2016 reported the most difficulty recruiting primary care physicians, obstetricians/gynecologists, dentists, and most categories of behavioral health workers.

• FQHCs indicated the greatest retention difficulties for most categories of behavioral health workers, especially psychiatric NPs, as well as primary care practitioners, and dentists.

Between 2014 and 2024, the New York State Department of Labor projects growing demand for direct care workers, including home health aides and personal care aides as well as RNs, social workers, and LPNs.

b Primary care physicians include general practice, family practice, general internal medicine, obstetrics/gynecology, and general pediatrics. c Psychiatrists include general psychiatrists and child and adolescent psychiatrists.

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II. BACKGROUND

A. Overview

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B. Objectives and Goals

The objectives of this report are to: • Describe health care employment trends in New York; and • Identify the health professions and occupations in greatest demand currently and offer projections for future demand.

The goals of this report are to: • Assist policy makers and other stakeholders to target health workforce education and job training resources to address the most pressing health workforce needs; • Guide health workforce policies, including decisions about the capacity of health professions education programs; and • Inform current and prospective students about health care employment prospects and opportunities.

C. Data Sources and Methods All data sources for this report are cited unless they are from primary data collection conducted by the Center for Health Workforce Studies (CHWS) and collaborating partners. The following is a list of data sources used in this report. When appropriate, the methods used for calculating the rates in this report are also described.

Information provided in this report is statewide or by New York State Department of Labor (NYSDOL) regions. A list of counties and a map depicting the NYSDOL regions are presented on pages 10 and 11.

Data sources include:

1. Center for Health Workforce Studies

• Surveys of Human Resources Directors in Health Care

CHWS, in conjunction with statewide and regional provider organizations, conducts annual surveys of human resources directors from FQHCs, home health care agencies, hospitals, and nursing homes across New York. The 2016 surveys ask about the professions and occupations that pose the greatest recruitment and retention problems, as well as emerging care coordination titles and employment trends. Recruitment and retention difficulty is assessed on a 1 (least difficult) to 5 (most difficult) scale. The provider organizations that CHWS collaborated with on these surveys included:

o Community Health Center Association of New York State o Continuing Care Leadership Coalition at the Greater New York Hospital Association o Healthcare Association of New York State o Home Care Association of New York State, Inc. o LeadingAge New York o New York State Association of Healthcare Providers, Inc.

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Home health care agencies serve patients in multiple counties and FQHCs also have sites in multiple counties, which may be located in different NYSDOL regions. Consequently, information on recruitment and retention for home health care agencies and FQHCs was reported in each region where services were provided or sites were located. In instances where total responses for a region (either by setting or occupation) were less than 5, no information is provided or contiguous regions are combined.

• New York State RN Graduations

CHWS surveys RN education programs in New York annually to understand trends in the supply of RNs in the state. The 2016 survey included questions about applications, acceptances, and graduations for that year as well as projected graduations through 2016.

• New York State Physician Data

Physician estimates were developed by using a number of different sources, including physician re-licensure survey data, and represents physicians actively working in New York. Counts used in this report represent bodies, with no estimation of time spent in patient care.

2. US Bureau of Labor Statistics (BLS) and the NYSDOL

Various labor department statistics used in this report are from federal and state sources. In 2010 there were some definitional changes in occupational titles, most notably RNs, personal care aides, and home health aides, which altered the course of previous trends in these professions. Prior to 2010, RNs included advanced practice nurses (NPs, certified nurse midwives, and certified registered nurse anesthetists), whereas currently, these categories are reported separately. Additionally, the previous definition for personal care aides included home health aides. In reviewing changes in counts among years, please be aware of these definitional changes for occupational employment statistics and projections data.

• Covered Employment and Wages Program (ES-202)

Counts of Jobs

Data from 2010-2014 were used to describe regional changes in health care employment by setting. A number of events potentially affected the information reported, including closures, mergers, and expansions. Consequently, large changes in jobs in specific health sectors (ie, hospitals, nursing homes, or home health care) may reflect a change in ownership or the service delivery system rather than changes in the workforce. At times, ES-202 survey responses could not be placed into regions. Consequently, summing the regions will not add up to the statewide total.

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• Occupational Employment Statistics (OES)

Wages

Wages are based on 2012, 2013, 2014, and 2015 Occupational Employment Survey (OES) data, which were then revised to the first quarter of 2016 by making cost-of-living adjustments. Average hourly salary was calculated by dividing average annual salary by 52 weeks and by 40 hours per week.

• Employment Projections

Employment projections used in this report reflect a count of the number of jobs in certain occupational categories and by health care setting. Every 2 years, employment projections are developed by BLS for the nation. NYSDOL develops projections for the state and by NYSDOL region, which are both for the period 2012-2022 (Regional) and 2014-2024 (Statewide). Annual job openings reflect both newly created positions in the occupation and turnover of workers in existing positions who retire, change jobs, or leave the occupation. Occupations with a small increase in the number of new jobs but a high number of annual openings typically reflect significant annual turnover within the occupation rather than expansion of the occupation. Limitations to these projections include unanticipated external factors such as recessions, change in scopes of work or education for specific occupational titles, changes in state and/or federal reimbursement, and/or advancements in technology.

3. State Education Department Licensure Data

The licensure data from 2010-2014 presented in this report reflects counts of licensed health professionals in New York. Each year in April, SED updates these data. Data are available from SED on the number of individuals licensed in a health profession. SED licenses more than 40 health professions, and individuals must secure a New York license before practicing in one of these health professions. Licensure data in a health profession represent the upper limit of the number of individuals in New York who can practice in a profession. It is important to recognize the limitations of these data; chiefly, that some individuals who are licensed in a health profession may be working either less than full-time or not at all in the profession, or may be working in the profession but in another state. Licensure data can, however, provide valuable information on major trends in the supply of health professionals in the state.

In reviewing licensure data, please be aware that:

• Social workers (SWs) are licensed in New York as either licensed clinical social workers (LCSWs) or licensed master social workers (LMSWs). Although some data sources provide statistics for LCSWs and LMSWs collectively as social workers, the licensing distinction is reflected for the purposes of understanding recruitment and retention difficulties. • NPs are licensed as RNs but certified in 1 of 16 NP specialties. Information presented in the report at the regional level represents a duplicated count across all specialties. The statewide count is unduplicated.

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• Counts of health professionals by county are based on the mailing address in the licensure file, which could be either a home or a practice location. Additionally, certain individuals in the file may be licensed to practice in New York but live in another state.d

4. US Census

The census is an official count of the entire US population, conducted once every 10 years, and the American Community Survey is conducted each year update the information. The 2010-2014 American Community Survey was used to describe selected population characteristics by NYSDOL regions. The population characteristics included total population, age structure, poverty, race/ethnicity, and education level. The education levels and rates were based on individuals aged 25 years and older.

5. New York State Community Health Indicator Report

These data from 2011-2013 (2010-2012 for cancer), were used to describe the health of the population by NYSDOL regions. The health indicators were obtained from Community Health Indicator Reports (CHIRS) and includes information on deaths, births, and hospitalizations. Both counts and rates are reported for the average of 3 years. The rates for calculating these health indicators are calculated as follows:

• Infant death rates are reported per 1,000 live births. • Total birth rates are reported per 1,000 females aged 15 to 44 years. • Teen birth rates are reported per 1,000 females aged 15 to 19 years. • Low-birthweight rates and percentage of late/no prenatal care are reported per 100 live births. Percent of late/no prenatal care was based on those births where information was provided and not on total births. • All deaths are reported per 100,000 total population. • Rates per 10,000 for adult asthma hospital admissions are based on population aged 18 and older. • Rates per 10,000 for pediatric asthma hospital admissions are based on population aged birth to 15 years. • All other rates per 10,000 for hospitalizations and emergency department (ED) visits are based on the total population.

6. New York State Department of Health SPARCS Data

The Statewide Planning and Research Cooperative System (SPARCS) collects patient-level information for all hospital inpatient stays, outpatient visits (including visits to hospital extension settings), and ED visits. Data from SPARCS were used to report the number of preventable hospitalizations. The numbers represent the average of 3 years, from 2011 to 2013, and the rates are based on per 10,000 average total population.

d The total listed in the report includes all New York licensed individuals regardless of whether the address given in the licensure file was a New York address, whereas tables of licensees by region include only those individuals with an address in the region.

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D. Terminology The settings used in this report are based on the North American Industry Classification System (NAICS) for the health care sector. The breakdown of settings within the health care sector is as follows:

• Hospitals (public and private); • Nursing and personal care facilities (excluding residential, mental retardation, mental health and substance abuse facilities, and other residential care facilities); • Home health care; and • Ambulatory care settings (excluding home health care), including: o Medical and diagnostic laboratories o Offices and clinics of doctors of medicine o Offices and clinics of dentists o Offices and clinics of other health practitioners o Outpatient care centers o Other ambulatory health services.

This classification scheme provides standardization among the data sets presented, but it has some limitations. By limiting the analyses to the NAICS health services industries, health care workers in hospital-sponsored ambulatory care sites may be included in hospital employment counts. Also, health care professionals in industries outside of the settings listed, such as those in schools, insurance firms, or who are self-employed, are excluded from the health sector counts. CHWS estimates that, nationally, one- fourth of the health care workforce is employed outside of the health care sector as defined by BLS (Figure 1, page 13).

Historically, OES groups occupations by category. These occupational categories also have limitations. For example, prior to 2010, registered nursing made no distinction between NPs, nurse midwives, and RNs. The nursing aides, orderlies, and attendants occupational category also includes multiple job titles, levels of training, and certifications and were separated into separate job categories in 2010.

There are some job titles in a health setting that may not necessarily reflect similar OES occupational classifications and this may cause some problems in reporting. For example, confusion may result from the differences in defining a home health aide as any individual providing services in the home, or as one who completes home health aide certification requirements. Additionally, throughout this report some abbreviations are used. The following is a list of the most common.

CNA certified nursing aide FPL federal poverty level FQHC federally qualified health center HIT health information technology LCSW licensed clinical social worker LMSW licensed master social worker LPN licensed practical nurse MDS minimum data set NP nurse practitioner Ob/Gyn obstetrician/gynecologist PA physician assistant RN registered nurse

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E. Geographic Areas

For purposes of this report, New York State Department of Labor regions are used as described below and as depicted in Figure 1.

The NYSDOL regions (Figure 1) used in this report are:

• Capital District: The counties of Albany, Columbia, Greene, Rensselaer, Saratoga, Schenectady, Warren, and Washington.

• Central New York: The counties of Cayuga, Cortland, Madison, Onondaga, and Oswego. • Finger Lakes: The counties of Genesee, Livingston, Monroe, Ontario, Orleans, Seneca, Wayne, Wyoming, and Yates.

• Hudson Valley: The counties of Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster, and Westchester.

• Long Island: The counties of Nassau and Suffolk. • Mohawk Valley: The counties of Fulton, Herkimer, Montgomery, Oneida, Otsego, and Schoharie. • New York City: The counties of Bronx, Kings (Brooklyn), New York (Manhattan), Queens, and Richmond (Staten Island).

• North Country: The counties of Clinton, Essex, Franklin, Hamilton, Jefferson, Lewis, and St. Lawrence.

• Southern Tier: The counties of Broome, Chemung, Chenango, Delaware, Schuyler, Steuben, Tioga, and Tompkins.

• Western New York: The counties of Allegany, Cattaraugus, Chautauqua, Erie, and Niagara.

For the purpose of this report, the term “upstate New York” is used to define all New York state regions outside of New York City.

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Figure 1. New York State Department of Labor Regions

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III. THE HEALTH CARE WORKFORCE IN THE UNITED STATES

A. Total Employment In 2014, there were nearly 20 million jobs either in the health sector or in health occupations employed outside the health sector, accounting for over 13% of the total US workforce. In 2014, almost 15 million of these jobs (10% of US employment) were in the health sector, including both health and non-health– related occupations. The remaining 4.8 million jobs (3% of US employment) were in health occupations in other sectors (Figure 2 and Table 1).

Figure 2. The US Health Workforce, 2014 (in Thousands)

The Health Sector Health Occupations Jobs

3,505.1 other 11,410.4 health care 4,784.7 health jobs in the occupations jobs in care occupations health care health care settings jobs in other sector sectors

Source: US Department of Labor, Bureau of Labor Statistics. Employment Projections program: Table 1.9, 2014-24 Industry- Occupation Matrix Data, by Industry; and Table 2.7, Employment and Output by Industry.

Table 1. The US Health Workforce, 2014 (in Thousands) Health Care Setting Other Jobs Total Occupation Jobs Health Care Settings 11,410.4 3,505.1 14,915.5 Other Work Settings 4,784.7 130,839.7 135,624.4 Total 16,195.1 134,344.8 150,539.9

Setting Number Percent Health Care Occupations Jobs in Health Care Settings 11,410.4 7.6% Other Jobs in Health Care Settings 3,505.1 2.3% Health Care Occupations Jobs in Other Settings 4,784.7 3.2% Total 19,700.2 13.1%

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B. By Setting Hospitals continued to employ the most health workers in the United States (39%), followed by offices of health practitioners (28%), nursing homes (17%), and both home health care and other ambulatory care settings, at about 8% each (Figure 3).

Figure 3. Percent Distribution of the Health Workforce in the United States, by Setting, 2014

8.3%

8.5%

38.7%

16.7%

27.8%

Hospitals Offices of health practitioners Nursing and residential care facilities Home health care services Other ambulatory care

Source: US Department of Labor, Bureau of Labor Statistics. Employment Projections program: Table 1.9, 2014-24 Industry-Occupation Matrix Data, by Industry; Table 2.7, Employment and Output by Industry.

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Between 2004 and 2014, employment in the nation’s health sector grew by 20%, while employment in other sectors increased by 3%. It is projected that between 2014 and 2024 health sector employment will grow at a significantly higher rate than employment in all other sectors. Health sector employment is projected to grow from nearly 15 million jobs in 2014 to more than 18 million jobs in 2024, an increase of nearly 22%, compared with only 5% growth for jobs in all other employment sectors (Figure 4).

Figure 4. Job Growth in the Health Care Sector Compared With All Other Employment Sectors in the United States, 2004-2014 and Projected 2014-2024 25% 21.8% 20.3% 20%

15%

10%

4.8% 5% 3.0%

0% 2004-2014 Actual 2014-2024 Projected

Other than health care Health care

Source: US Department of Labor, Bureau of Labor Statistics. Employment Projections program: Table 1.9, 2014-24 Industry-Occupation Matrix Data, by Industry; and Table 2.7, Employment and Output by Industry.

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Nationally, home health care is projected to experience the fastest job growth in the health care sector, with an overall growth of 60% between 2014 and 2024, adding over 760,000 jobs during that period. In addition, offices of health practitioners are projected to add more than 1 million jobs during the same 10- year period, with an overall growth of 25%.

Between 2014 and 2024, jobs in nursing and residential care facilities are projected to grow by 22%, adding over 730,000 jobs, and hospitals are projected to grow by 6% during the same period, adding almost 370,000 jobs (Figure 5).

Figure 5. Actual and Projected Growth of Selected Occupational Settings in the Health Care Sector in the United States, 2004-2014 and Projected 2014-2024 70% 62.5% 60.2% 60%

50%

40%

30% 24.3% 25.0% 22.3% 20% 15.5% 9.2% 10% 6.4% 3.0% 4.8%

0% Other than health Home health care Offices of health Nursing and Hospitals care practitioners residential care facilities

2004-2014 Actual 2014-2024 Projected

Source: US Department of Labor, Bureau of Labor Statistics. Employment Projections program: Table 1.9, 2014-24 Industry-Occupation Matrix Data, by Industry; and Table 2.7, Employment and Output by Industry.

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C. By Occupation Of the total health care workforce in the United States in 2014, RNs (17%) were the single largest health occupation, followed by personal care aides (11%), nursing assistants (9%), and home health aides (6%) (Figure 6).

Figure 6. Health Care Occupations in the United States, 2014

Registered Nurses 16.8%

Nursing Assistants 9.1%

Personal Care Aides 10.8%

Home Health Aides 5.6%

Licensed Practical Nurses 4.4%

Physicians 4.4%

Medical Assistants 3.6%

Medical Secretaries 3.2%

Pharmacy Technicians 2.3%

Dental Assistants 2.0%

0.0% 5.0% 10.0% 15.0% 20.0%

Source: Martiniano R, Chorost S, Moore J. Health Care Employment Projections, 2014-2024: An Analysis of Bureau of Labor Statistics Projections by Setting and by Occupation. Rensselaer, NY: Center for Health Workforce Studies, School of Public Health, SUNY Albany; April 2016.

Twenty of the top-30 fastest-growing occupations between 2014 and 2024 are in health care. Jobs for both occupational therapy assistants and physical therapist assistants are projected to increase substantially between 2014 and 2024, both by more than 40%. The projected top 10 fastest-growing health occupations include:

• Occupational therapy assistants (42.7%) • Physical therapist assistants (40.6%) • Physical therapist aides (39.0%) • Home health aides (38.1%) • Nurse practitioners (35.2%) • Physical therapists (34.0%) • Occupational therapy aides (30.6%) • Physician assistants (30.4%) • Genetic counselors (28.8%) • Audiologists (28.6%)

Source: US Department of Labor, Bureau of Labor Statistics. Employment Projections program: Table 1.3, Fastest growing occupations, 2014 and projected 2024 (Numbers in thousands).

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The need for workers, however, includes both new job openings and replacement of existing staff due to turnover. Between 2014 and 2024, nearly 1.1 million new RNs will be needed nationwide, including almost 650,000 to replace RNs leaving the profession. During the same period, over 600,000 personal care aides, nearly 600,000 nursing assistants, about 555,000 home health aides, and over 320,000 LPNs will be needed to fill new and existing jobs (Figure 7).

Figure 7. Selected Health Occupations With the Largest Projected Job Need in the United States, 2014-2024 (in Thousands)

Registered Nurses 439.3 649.1

Personal Care Aides 458.1 143.0

Nursing Assistants 262.0 337.0

Home Health Aides 348.4 206.3 Licensed Practical 117.3 204.9 Nurses

Medical Assistants 138.9 123.3

Medical Secretaries 108.2 55.6 Medical/Health 56.3 84.2 Services Managers

Dental Assistants 58.6 78.8

Physical Therapists 71.8 56.5

0 200 400 600 800 1000 1200

New jobs Replacement In thousands

Source: US Department of Labor, Bureau of Labor Statistics. Employment Projections program: Table 1.9, 2014-24 Industry- Occupation Matrix Data, by Industry.

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IV. NEW YORK HEALTH SECTOR EMPLOYMENT

A. Total Employment In 2014, health sector employment accounted for 12% of total employment in New York, somewhat higher than the national level. However, this rate did not include those health professionals working in other employment sectors outside the health sector, such as nurses working in educational settings or pharmacists working in settings such as retail pharmacies or supermarkets (Figure 8).

Figure 8. Health Sector Employment as a Percentage of Total Employment, 2014 14%

12.1% 12%

9.9% 10%

0% New York United States

Sources: US Department of Labor, Bureau of Labor Statistics. Employment Projections program: Table 1.9, 2014-24 Industry- Occupation Matrix Data, by Industry; and Table 2.7, Employment and Output by Industry; New York State Department of Labor, ES- 202.

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Between 2000 and 2014, health care employment in New York grew by nearly 24%, adding over 160,000 jobs, while employment in all other sectors grew by about 48,000 (less than 1%). Between 2008 and 2009 employment in the health sector increased by over 17,000 jobs, or nearly 2%, while employment in all other sectors declined by nearly 300,000 jobs.

Additionally, between 2003 and 2014, employment in health care in New York increased by about 20%, while employment in all other sectors only grew by about 4% (Figure 9).

Figure 9. Employment Growth in New York, 2000-2014 (Standardized to 2000)

125%

120%

115%

Health Care 110%

105%

100%

All Other Sectors 95%

90%

Source: New York State Department of Labor, ES-202.

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Since 2000, health sector employment in New York has grown rapidly. The average annual growth in the health sector since 2000 has been nearly 1.5% annually, with more pronounced growth in 2013 and 2014. (Figure 10).

Figure 10. Employment Growth in Total Health Sector Employment in New York, 2000-2014

1,100,000

1,050,000

1,000,000

950,000

900,000

850,000

Source: New York State Department of Labor, ES-202.

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Employment Growth in Regions Outside of New York City e

The difference in the growth between health care sector and non-health care sector jobs was most pronounced in regions outside of New York City. Although employment in the health care sector increased by nearly 17% between 2000 and 2014 in upstate New York, employment outside of the health care sector declined by around 6% during that same period. Between 2000 and 2008 employment outside of health care remained relatively steady, but in 2009 and again in 2013 employment dropped significantly in non- health care sectors in upstate New York. After 2010 the annual growth in health care employment began to slow (Figure 11).

Figure 11. Employment Growth in Regions Outside of New York City, 2000-2014 (Standardized to 2000)

120%

115%

110% Health Care

105%

100%

95% All Other Sectors

90%

Source: New York State Department of Labor, ES-202.

e For New York City employment growth, please see page 49, Figure 19.

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B. Health Sector Employment

Between 2000 and 2014, employment in New York’s health sector increased by nearly 24%. Home health care settings (136%) had the largest increase in employment, more than doubling during this period. Ambulatory care settings also experienced substantial growth, employing about 30% more people in 2014 than were employed in 2000. In contrast, nursing homes and hospitals added significantly fewer jobs, with employment growth for these settings at 12% and 7%, respectively (Table 2).

Table 2. Number of Health Care Jobs in New York, by Setting, 2000, 2014 Number Percent Setting 2000 2014 Change Change Hospitals 410,300 437,325 27,025 6.6% Ambulatory care 245,600 319,470 73,870 30.1% (excluding home health) Nursing home and personal 143,200 159,819 16,619 11.6% care facilities Home health care 64,600 152,256 87,656 135.7% Total 863,700 1,068,870 205,170 23.8% Source: New York State Department of Labor, ES-202.

Although hospitals had much smaller growth rates, these facilities remained the most prominent employer for New York’s health sector in 2014, employing 41% of those working in the health sector. Ambulatory care provided 30% of health sector jobs in New York, while nursing home and personal care facilities and home health care each contributed about 14% of health care positions (Figure 12).

Figure 12. Health Sector Employment in New York, by Setting, 2014

Home health care 14.2%

Nursing home Hospitals and personal 40.9% care facilities 15.0%

Ambulatory care (excluding home health) 29.9%

Sources: New York State Department of Labor, ES-202.

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C. By Region Health sector employment in New York grew by almost 6% between 2010 and 2014. In 2014, the New York City region had nearly 485,000 health sector jobs and the Long Island region had more than 165,000 health sector jobs, reflecting increases of 11% and 2%, respectively, between 2010 and 2014. Health sector employment in the Southern Tier region remained stable during the same period (Table 3), while health sector employed in the Mohawk Valley and Western New York regions declined.

Table 3. Total Health Sector Employment in New York, by Department of Labor Region, 2010-2014 Change Between 2010 Region 2010 2011 2012 2013 2014 and 2014 Number Percent Capital District 54,521 55,320 56,097 56,459 57,226 2,705 5.0% Central New York 37,093 37,367 38,500 38,941 39,123 2,030 5.5% Finger Lakes 60,999 61,889 62,521 63,357 64,791 3,792 6.2% Hudson Valley 110,546 111,655 111,528 111,702 113,251 2,705 2.5% Long Island 161,395 164,628 163,830 164,474 165,458 4,063 2.5% Mohawk Valley 27,195 27,019 26,861 26,905 26,247 -948 -3.5% New York City 435,264 441,651 447,956 466,456 484,870 49,606 11.4% North Country 17,564 17,784 17,899 17,897 18,215 651 3.7% Southern Tier 28,648 28,925 29,081 29,089 28,650 2 0.0% Western New 71,456 71,384 70,649 70,964 71,039 -417 -0.6% York Total 1,006,782 1,020,423 1,028,317 1,046,244 1,068,870 55,288 5.6% Sources: New York State Department of Labor, ES-202.

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Between 2010 and 2014, the number of health care jobs per capita across the state increased by over 4%. The Long Island region had the highest number of health care jobs per capita in 2014 with 5,782 jobs per 100,000 total population, followed by New York City with 5,710 jobs per 100,000 total population (Table 4).

The North Country had the lowest number of health care jobs per 100,000 total population in 2014 with 4,197, followed by the Southern Tier with 4,390 health care jobs per 100,000 total population. The Mohawk Valley had the highest percentage of jobs in health care to total jobs in 2014 (14%), followed by Long Island (13.4%) and Hudson Valley regions (12.8%) (Table 4).

Table 4. Total Employment and Health Sector Employment in New York, by Department of Labor Region, 2010, 2014 2010 2014

Region Jobs per 100,000 % of Jobs in Jobs per 100,000 % of Jobs in Population Health Care Population Health Care

Capital District 5,052.0 11.1% 5,269.3 11.3% Central New York 4,683.8 11.0% 4,956.5 11.5% Finger Lakes 5,011.6 11.4% 5,316.7 11.9% Hudson Valley 4,825.5 12.9% 4,870.9 12.8% Long Island 5,697.2 13.6% 5,782.0 13.4% Mohawk Valley 5,437.3 14.2% 5,321.9 14.1% New York City 5,324.2 12.1% 5,710.4 12.2% North Country 4,054.5 11.6% 4,196.9 12.2% Southern Tier 4,354.4 10.9% 4,390.4 11.0% Western New York 5,105.2 11.7% 5,093.3 11.4% Total 5,195.5 12.3% 5,413.0 12.3% Source: New York State Department of Labor, ES-202; US Census Bureau.

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1. Hospital Employment

Between 2010 and 2014, hospital employment in New York increased by more than 8,000 jobs, or 2%.f The Finger Lakes region experienced the largest percentage increase in hospital employment (7.3%) between 2010 and 2014, followed by the New York City (4.5%) and Central New York regions (4.4%). The New York City region experienced the largest growth in the number of new hospital jobs, with slightly more than 9,000 new jobs, followed by the Finger Lakes region with an increase of more than 2,000 hospital jobs. The Hudson Valley, Long Island, Mohawk Valley, North Country, and Western New York regions all saw a loss of hospital jobs between 2010 and 2014 (Table 5).

Table 5. Hospital Employment in New York, by Department of Labor Region, 2010-2014 Change Between Region 2010 2011 2012 2013 2014 2010 and 2014 Number Percent Capital District 23,057 23,541 23,796 23,902 23,522 465 2.0% Central New York 13,133 13,202 13,781 13,869 13,715 582 4.4% Finger Lakes 28,258 28,916 29,436 29,546 30,306 2,048 7.3% Hudson Valley 39,765 39,311 38,351 37,400 38,157 -1,608 -4.0% Long Island 62,646 64,558 62,754 62,687 61,907 -739 -1.2% Mohawk Valley 12,501 12,359 12,153 12,069 11,435 -1,066 -8.5% New York City 200,675 198,908 202,774 205,813 209,677 9,002 4.5% North Country 8,991 9,190 9,251 8,982 8,957 -34 -0.4% Southern Tier 12,943 13,319 13,659 13,694 13,396 453 3.5% Western New York 27,348 27,071 26,800 26,717 26,153 -1,195 -4.4% Total 429,323 430,380 432,758 434,685 437,346 8,023 1.9%

Source: New York State Department of Labor, ES-202.

f Recent layoffs, closures, or mergers are not reflected in these numbers, either at the state or regional levels.

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2. Ambulatory Care Employment in ambulatory care settings (excluding home health care) increased by nearly 7% between 2010 and 2014, adding nearly 20,000 jobs. The Capital District and New York City regions saw the largest percentage increases both growing by more than 11% during the same period. The number of ambulatory care jobs in New York City increased by more than 12,000 between 2010 and 2014, followed by the Long Island and Hudson Valley regions. Ambulatory care employment in the Southern Tier declined slightly during the same time period (Table 6).

Table 6. Ambulatory Care Services Employment (Excluding Home Health Care) in New York, by Department of Labor Region, 2010-2014 Change Between Region 2010 2011 2012 2013 2014 2010 and 2014 Number Percent Capital District 17,222 17,461 17,735 18,264 19,118 1,896 11.0% Central New York 13,414 13,644 14,125 14,337 14,677 1263 9.4% Finger Lakes 16,457 16,505 16,536 17,225 17,497 1,040 6.3% Hudson Valley 40,676 41,085 42,068 42,774 42,939 2,263 5.6% Long Island 61,385 62,110 62,528 63,485 63,968 2,583 4.2% Mohawk Valley 6,646 6,635 6,757 6,753 6,755 109 1.6% New York City 105,439 108,007 109,951 112,658 117,446 12,007 11.4% North Country 5,103 5,137 5,180 5,286 5,358 255 5.0% Southern Tier 7,703 7,740 7,586 7,591 7,572 -131 -1.7% Western New York 23,372 23,640 22,958 23,478 24,140 768 3.3% Total 299,278 304,422 308,334 311,851 319,470 20,192 6.8% Sources: New York State Department of Labor, ES-202.

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3. Nursing and Personal Care Facility Employment

Employment in nursing and personal care facilitiesg in New York decreased by 3% between 2010 and 2014, with 2 regions accounting for the majority of the overall decrease in the number of jobs. New York City experienced the largest percentage decline of 6.8%. The New York City region lost 3,700 nursing and personal care facilities jobs, while nursing and personal care facility jobs in Long Island dropped by over 1,300. The Hudson Valley region had the largest gain in nursing and personal care facility employment (513), followed by the Finger Lakes region (488) (Table 7).

Table 7. Nursing and Personal Care Facility Employment in New York, by Department of Labor Region, 2010-2014 Change Between Region 2010 2011 2012 2013 2014 2010 and 2014 Number Percent Capital District 11,194 11,240 11,413 11,132 11,167 -27 -0.2% Central New York 9,142 8,929 8,765 8,623 8,589 -553 -6.1% Finger Lakes 12,811 12,746 12,817 13,059 13,299 488 3.8% Hudson Valley 20,605 20,742 20,767 20,746 21,118 513 2.5% Long Island 24,244 24,399 23,918 22,722 22,934 -1,310 -5.4% Mohawk Valley 6,632 6,561 6,555 6,693 6,692 60 0.9% New York City 54,439 53,554 51,182 51,102 50,742 -3,697 -6.8% North Country 2,937 2,920 2,937 3,040 3,063 126 4.3% Southern Tier 6,901 6,733 6,706 6,665 6,621 -280 -4.1% Western New York 15,844 15,644 15,618 15,436 15,594 -250 -1.6% Total 164,753 163,521 160,811 159,218 159,819 -4,934 -3.0% Sources: New York State Department of Labor, ES-202.

g Includes nursing care facilities and community care facilities for the elderly but excludes residential mental retardation, mental health and substance abuse facilities, and other residential care facilities.

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4. Home Health Care Between 2010 and 2014, employment in home health care in New York grew by more than 38,000 jobs, with the New York City region accounting for the vast majority of the increase. Jobs in home health care in New York City grew more than 43%, adding over 32,000 jobs. Outside of New York City, the Long Island region experienced the next largest increase in home health care employment, growing by more than 3,500 jobs between 2010 and 2014, or 27%, followed by the Hudson Valley region, which added more than 1,500 jobs, or 16%. Employment in home health care agencies in the Mohawk Valley region experienced a small decline, losing 51 jobs during the same period (Table 8).

Table 8. Home Health Care Employment in New York, by Department of Labor Region, 2010-2014 Change Between Region 2010 2011 2012 2013 2014 2009 and 2013 Number Percent Capital District 3,049 3,078 3,154 3,161 3,419 370 12.1% Central New York 1,404 1,593 1,829 2,112 2,142 738 52.6% Finger Lakes 3,473 3,722 3,732 3,527 3,589 116 3.3% Hudson Valley 9,499 10,517 10,343 10,782 11,037 1,538 16.2% Long Island 13,120 13,561 14,630 15,580 16,649 3,529 26.9% Mohawk Valley 1,416 1,464 1,396 1,390 1,365 -51 -3.6% New York City 74,711 81,182 84,049 96,883 107,005 32,294 43.2% North Country 532 538 531 589 837 305 57.3% Southern Tier 1,102 1,133 1,131 1,139 1,061 -41 -3.7% Western New York 4,892 5,030 5,272 5,333 5,152 260 5.3% Total 113,429 122,100 126,413 140,496 152,256 38,827 34.2% Source: New York State Department of Labor, ES-202.

D. By Occupation 1. Current Employment Data

Changes in the number of health care jobs in New York varied by occupation. Although this represents positions and not individuals or full-time equivalents (FTEs), it is useful in identifying trends in occupations and job titles. Notable changes between 2010 and 2014 included:

• The number of personal care aide jobs increased by 40,690, or 40.1%. • The number of occupational therapist jobs increased by over 2,000, or 29%. • The number of RN jobs remained relatively stable, declining by 150, or 0.1%. • The number of social worker jobs declined by nearly 1,500, or 2.7%.

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h Table 9. Number of Jobs in Selected Health Occupations in New York, 2010-2014 h Change Between Occupation 2010 2011 2012 2013 2014 2010 and 2014 Number Percent Registered Nurses 169,710 176,180 166,950 169,820 169,560 -150 -0.1% Personal Care Aides 101,530 115,920 127,860 136,140 142,220 40,690 40.1% Home Health Aides 137,830 133,980 123,260 128,480 146,550 8,720 6.3% Nursing Assistants NA NA 98,340 99,820 101,030 NA NA Social Workers 55,990 51,790 50,760 52,520 54,500 -1,490 -2.7% Licensed Practical Nurses 45,100 47,950 48,520 49,050 47,550 2,450 5.4% Medical and Health Services Managers 27,260 27,340 26,630 27,530 27,840 580 2.1% Medical Assistants 20,950 21,360 21,650 23,170 23,780 2,830 13.5% Pharmacists 16,660 17,820 18,970 19,060 18,870 2,210 13.3% Dental Assistants 16,730 17,760 17,420 17,970 18,700 1,970 11.8% Pharmacy Technicians 14,340 15,730 16,260 16,770 16,580 2,240 15.6% Physical Therapists 13,740 13,490 13,930 14,170 15,310 1,570 11.4% Radiologic Technologists NA NA 12,210 12,660 13,190 NA NA Medical Secretaries 9,530 9,900 10,990 10,790 11,480 1,950 20.5% Speech-Language Pathologists 8,340 8,870 9,220 10,280 9,950 1,610 19.3% Medical and Clinical Laboratory 8,240 7,920 7,260 9,850 7,580 -660 -8.0% Technicians Dental Hygienists 9,710 9,690 9,630 9,850 9,960 250 2.6% Medical & Clinical Laboratory 10,460 10,820 9,910 9,830 9,600 -860 -8.2% Technologists Physician Assistant 9,220 9,690 9,320 9,780 10,410 1,190 12.9% Nurse Practitioners NA NA 8,990 9,610 10,310 NA NA Medical Records and Health Info Techs 9,630 9,520 9,200 8,850 8,580 -1,050 -10.9% Occupational Therapists 7,100 7,300 7,650 8,710 9,160 2,060 29.0% Physical Therapist Assistants/Aides 6,480 6,040 6,730 7,050 7,470 990 15.3% Respiratory Therapists 5,810 5,900 6,080 5,980 6,000 190 3.3% Surgical Technologists 4,800 5,000 5,060 4,980 5,080 280 5.8% Dietitians and Nutritionists 4,520 4,620 4,510 4,330 4,520 0 0.0% Orderlies NA NA 3,860 3,850 4,980 NA NA Cardiovascular Technologists & 2,760 2,960 2,880 2,710 2,690 -70 -2.5% Technicians Occupational Therapy Assistants/Aides 2,320 2,370 2,350 2,400 2,470 150 6.5% Certified Registered Nurse Anesthetists NA NA 1,220 1,580 1,430 NA NA Nuclear Medicine Technologists 1,230 1,090 1,110 1,190 1,330 100 8.1% Dietetic Technicians 1,190 1,060 900 790 840 -350 -29.4% Nurse Midwives NA NA 530 490 450 NA NA Source: US Department of Labor, Bureau of Labor Statistics, Occupational Employment Statistics.

h Prior to 2010, RNs included advanced practice nurses (NPs, certified nurse midwives, and certified registered nurse anesthetists). Radiologic technologists were reported separately starting in 2012. Additionally, the previous definition for personal care aides included home health aides.

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Average wages per hour in selected health occupations for New York are reported in Table 10. These wages are based on 2012-2015 survey data, which were adjusted to include the first quarter of 2016. Certified registered nurse anesthetists earned the highest hourly wage in 2016 ($78.35), followed by medical and health service managers, and pharmacists ($63.21 and $57.35, respectively). Physical therapist aides ($13.55), personal care aides ($12.22), and home health aides ($11.46) were the lowest wage earners in health care.

Table 10. Average Hourly Wage in Selected Health Occupations in New York, 2016 Occupation Average Wage per Hour Nurse Anesthetists $78.35 Medical and Health Services Managers $63.21 Pharmacists $57.35 Nurse Practitioners $52.11 Physician Assistants $49.76 Nurse Midwives $47.43 Speech-Language Pathologists $42.75 Physical Therapists $41.52 Occupational Therapists $39.54 Nuclear Medicine Technologists $38.90 Registered Nurses $38.50 Dental Hygienists $35.57 Respiratory Therapists $33.94 Radiologic Technologists and Technicians $32.49 Medical and Clinical Laboratory Technologists $32.49 Dietitians and Nutritionists $30.71 Cardiovascular Technologists and Technicians $28.58 Social Workers $27.97 Occupational Therapy Assistants $27.52 Physical Therapist Assistants $25.74 Surgical Technologists $25.13 Medical and Clinical Laboratory Technicians $22.92 Licensed Practical and Licensed Vocational Nurses $22.68 Medical Records and Health Information Technicians $21.30 Mental Health Counselors $20.79 Dietetic Technicians $19.83 Medical Secretaries $18.77 Dental Assistants $17.53 Orderlies $17.06 Medical Assistants $16.80 Nursing Assistants $16.37 Occupational Therapy Aides $15.65 Pharmacy Technicians $15.57 Physical Therapist Aides $13.55 Personal Care Aides $12.22 Home Health Aides $11.46 Source: New York State Department of Labor, Labor Statistics, Occupational Wages.

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2. Licensure Data for Selected Health Professions in New York

Between 2010 and 2014, the number of licensed RNs in New York increased by more than 10,000, or 4%. Physician assistants had the largest percentage increase, growing by 31% during the same period. The number of NPs also grew by 29% between 2010 and 2014. In contrast, the number of clinical laboratory technicians and clinical laboratory technologists saw a decrease of 11% and 2%, respectively, during the same period (Table 11).

i Table 11. Number of Licensed Individuals in Selected Health Occupations in New York, 2010-2014 i Change Between Profession 2010 2011 2012 2013 2014 2010 and 2014 Number Percent Registered Nurses 269,947 270,691 273,052 280,973 280,236 10,289 3.8% Licensed Practical Nurses 69,568 71,239 70,903 71,813 72,441 2,873 4.1% Social Workers 48,430 50,391 51,685 53,964 55,353 6,923 14.3% Pharmacists 21,863 22,431 23,275 24,210 25,816 3,953 18.1% Physical Therapists 19,987 19,845 20,309 21,086 21,819 1,832 9.2% Nurse Practitioners 15,395 16,268 17,117 18,815 19,825 4,430 28.8% Speech-Language Pathologists 14,222 14,981 15,675 16,487 16,852 2,630 18.5% Clinical Laboratory Technologist 15,118 14,808 14,905 14,665 14,882 -236 -1.6% Physician Assistants 10,168 10,688 11,275 12,172 13,316 3,148 31.0% Occupational Therapists 10,320 10,650 11,066 11,568 11,963 1,643 15.9% Dental Hygienists 10,200 10,449 10,603 10,880 11,110 910 8.9% Respiratory Therapists 5,279 5,534 5,640 5,892 6,053 774 14.7% Physical Therapist Assistants 4,957 4,943 5,236 5,617 5,893 936 18.9% Dietitians/Nutritionists 4,934 4,918 5,138 5,336 5,393 459 9.3% Occupational Therapy Assistants 3,856 3,981 4,060 4,005 3,952 96 2.5% Clinical Laboratory Technician 2,300 2,098 2,125 2,046 2,054 -246 -10.7% Source: New York State Education Department, Office of Professions.

E. Primary Care Physicians There were nearly 26,000 primary care physicians practicing in New York. Forty-four percent (44%) of primary care physicians practiced general internal medicine, 22% were in family and general practice, and 21% were in general pediatrics. There were 74.6 obstetricians/gynecologists (Ob/Gyns) per 100,000 women aged 15 to 44 and 127.0 general pediatricians per 100,000 for children from birth to 17 years of age. There were nearly 6,300 psychiatrists, including child and adolescent psychiatrists, practicing in New York State, or approximately 32 per 100,000 population (Table 12).

i This total includes all New York licensed individuals regardless of whether the address given in the licensure file was a New York address, whereas tables of licensees by region include only those individuals with an address in the region.

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Table 12. Primary Care Physicians and Psychiatrists in New York, by Specialty, 2015 Per 100,000 Specialty Physicians a Population Family/General Practice 5,527 28.2 Internal Medicine (General) 11.188 57.1 Subtotal 16,715 85.5 Geriatrics 362 13.1 Obstetrics/Gynecology 3,022 74.6 Pediatrics (General) 5,427 127.0 Primary Care Total 25,526 N/A Psychiatrist 6,275 32.0 a All rates are per 100,000 total population except the Ob/Gyn rate, which is per 100,000 women aged 15 to 44, the pediatrician rate, which is per 100,000 children aged birth to 17 years, and the geriatrics rate, which is per 100,000 population aged 65 and older. Source: Center for Health Workforce Studies.

While the statewide supply of primary care physicians and psychiatrists appears to be ample, it is widely recognized that these providers are unevenly distributed across regions, within regions at the county level, and at sub-county levels. The maldistribution of providers contributes to access to care barriers for underserved populations, including those that are Medicaid-eligible. As of December 31st, 2016, New York had nearly 4 million individuals in primary care health professional shortage areas (HPSAs) and slightly more than 2 million individuals in dental care HPSAs, most of which are designations that target Medicaid- eligibles.j

The New York City region had the highest rate of family/general practice and internal medicine (general) physicians with 89.6 per 100,000, while the Mohawk Valley had the lowest (61.5 per 100,000). The Finger Lakes region had the largest share of geriatric physicians with 22.3 per 100,000, and the Capital District had the least (2.5 per 100,000). The region with the highest share of obstetrics/gynecology physicians was the Long Island region with 86.6 per 100,000, and the Southern Tier region had the least (52.0 per 100,000). The New York City region also had the highest share of general pediatric physicians with 145.3 per 100,000 and the Southern Tier had the least (62.8 per 100,000). Additionally, the New York City region had the most psychiatrists (43.0 per 100,000), while the Western New York region and the Mohawk Valley had the least (13.8 per 100,000 and 13.7 per 100,000, respectively) (Table 13).

j https://datawarehouse.hrsa.gov/tools/quickreports.aspx

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Table 13. Primary Care Physicians and Psychiatrists per 100,000 Population in New York, by Region, 2015

Family/General Practice and Internal Medicine Geriatrics Obstetrics/Gynecology Pediatrics (General) Psychiatry Specialty (General) Per 100,000 Per 100,000 Per 100,000 Per 100,000 Per 100,000 Counts Counts Counts Counts Counts Population Populationa Populationa Populationa Population

Capital District 906 83.7 2.5 66.0 100.9 20.1 4 137 224 217

Central New York 75.2 7.1 67.3 96.1 17.3 595 8 105 167 137

Finger Lakes 84.4 22.3 75.2 114.3 18.5 1,028 41 176 302 226

Hudson Valley 86.1 11.5 82.0 140.2 40.3 1,990 38 354 771 931

Long Island 86.6 11.8 86.6 134.9 25.4 2,469 51 458 878 723

Mohawk Valley 61.5 9.7 57.4 65.5 13.7 381 8 52 68 85

New York City 89.6 17.9 74.8 145.3 43.0 7,480 187 1,444 2,595 3,595

North Country 68.2 4.4 57.5 67.3 15.1 297 3 46 63 66

Southern Tier 85.3 6.4 52.0 62.8 15.6 559 7 66 83 103

Western New York 72.2 6.6 69.8 93.4 13.8 1,009 15 185 276 193 a The obstetrics/gynecology rate is per 100,000 women aged 15 to 44. The pediatrics rate is per 100,000 children aged birth to 17 years. The geriatrics rate is per 100,000 population aged 65 and older.

Source: Center for Health Workforce Studies.

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F. Trends in New York RN Education, 2005-2016 CHWS annually surveys RN education programs in New York to better understand trends in the production of RNs in the state. The 2015-16 survey included questions about applications, acceptances, and graduations for that year, as well as projected graduations through 2016. Of the 121 programs identified for this survey, a total of 112 deans and directors responded, which resulted in a 93% response rate. Data for the non-respondents were carried over from previous surveys; consequently, the following data reflects estimates of graduations for all RN education programs in the state.

In 2015, there were 11,578 graduates from RN education programs in New York, an increase of more than 400, or nearly 4%, compared with 2014 (Figure 13). Between 2014 and 2015, the number of associate degree in nursing (ADN) graduates declined slightly, while the number of (BSN)k graduates increased by more than 550 (9%) during the same period. The number of RN graduations in New York in 2016 is expected to grow by 49, or 0.4%, compared with 2015. ADN graduations are projected to decrease between 2015 and 2016, while increases are projected for BSN graduates and for BSN completers.

Figure 13. RN Graduations in New York, by Degree Type, 2005-2016 13,000 12,000 11,000 10,000 9,000 Total 8,000 7,000 6,000 Associate 5,000 4,000 Bachelor's 3,000 2,000 1,000 0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Source: Center for Health Workforce Studies.

Since 2007, there has been a steady rise in the number of graduates from BSN completer programs, and as a result, they account for an increasing share of BSN graduates and total RN graduates. In 2015, BSN

k BSN completers are those RNs who already have either an RN associates degree or a diploma and continue their educations to complete a BSN.

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completers accounted for 38% of all BSN graduates and 21% of all RN graduates, up from 26% and 11%, respectively, in 2007 (Figure 14). In 2016, it is projected that BSN completers will account for 39% of BSN graduates and 22% of all RN graduates. If RN production is assessed for newly licensed RNs only (ADNs, RN Diploma, and 4-year BSN), excluding BSN completers, RN production is projected to decline slightly between 2015 and 2016, from 9,102 to 9,007.

Figure 14. Graduations from BSN 4-Year and BSN Completer Programs, 2005-2016

8,000

7,000

6,000

5,000

4,000

3,000

2,000

1,000

0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

4-year BSN graduates BSN completer graduates

Source: Center for Health Workforce Studies.

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Between 2005 and 2015, RN graduations from privately-sponsored RN education programs, including those based in hospitals, more than doubled, increasing by 117% (Figure 15). During the same period, RN graduations from CUNY- and SUNY-sponsored RN education programs increased by 56% and 26%, respectively. In 2015, nearly 52% of all RN graduates in the state attended privately-sponsored RN education programs, 36% attended SUNY-sponsored RN education programs, and 12% attended CUNY- sponsored RN education programs.

RN graduations from privately-sponsored RN education programs are projected to increase by just over 1% between 2015 and 2016, while graduations from CUNY-sponsored RN programs are expected to decrease by more than 4%, and SUNY-sponsored RN programs are expected to experience no change. Beginning in 2015, privately-sponsored RN education programs graduated more RNs than publicly- sponsored RN education programs, and that trend is expected to continue through 2016.

Figure 15. Graduations from New York RN Education Programs, by Sponsor, 2005-2016

6,500 Private 6,000

5,500

5,000

4,500

4,000 SUNY 3,500

3,000

2,500

2,000

1,500 CUNY 1,000

500 0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Source: Center for Health Workforce Studies.

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Between 2012 and 2015, the percentage of deans and directors that reported a similar number (compared to the previous year) of applications to their respective RN education programs has grown, increasing from 32% in 2012 (compared to 2011) to 54% in 2015 (compared to 2014). During the same time period, the percentage of deans and directors that reported an increase in the number of applications to their respective RN education programs has declined, from 56% in 2012 (compared to 2011) to 26% in 2015 (compared to 2014). In 2015, 60% of ADN and 47% of BSN deans and directors reported applications remained the same compared to 2014, while 21% of ADN and 41% of BSN deans and directors reported increases in applications to their programs between 2014 and 2015 (Figure 16).

Similarly, between 2012 and 2015, the percentage of deans and directors that reported the same number of acceptances to their respective RN education programs from the previous year has grown, increasing from 45% in 2012 (compared to 2011) to 75% in 2015 (compared to 2014). Seventy-nine percent of ADN and 70% of BSN deans and directors reported the same number of acceptances into their programs in 2015 as in 2014, while only 5% of ADN and 21% of BSN deans and directors reported increases in acceptances between 2014 and 2015.

Figure 16. Change in the Number of Acceptances from Previous Year in New York, by Program Type, 2006-2015

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0% 2006 2007 2009 2010 2012 2013 2014 2015 2006 2007 2009 2010 2012 2013 2014 2015

ADN BSN Increased The same Decreased

Source: Center for Health Workforce Studies.

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In 2015, a much higher percentage of deans and directors reported that “many jobs” were available in nursing for newly trained RNs (Figure 17). In comparison to recent years, 56% of deans and directors reported “many jobs”, nearly double the percentage in 2014 (29%). While deans and directors reported the availability of “many jobs” across all health care settings for newly trained RNs, they indicated growth was most notable in nursing homes and home health care agencies.

Figure 17. Percentage of RN Program Directors in New York Reporting “Many Jobs” for Newly Licensed RNs, 2009-2015

60% 56% 56% 53% 51% 48% 49% 42% 40% 40% 41% 38% 40% 35% 35% 33%34% 30% 31% 32% 29% 28% 28% 28% 25% 25% 25% 22% 18% 20% 17%

0% Overall Hospitals Nursing Homes Home Health Care Ambulatory Care

2009 2010 2012 2013 2014 2015

Source: Center for Health Workforce Studies.

There were, however, differences by degree type. RN program deans and directors reported that the job market was considerably better for newly trained BSNs than newly trained ADNs (Figure 16). This was especially true in hospitals and home health care agencies. In contrast, the job market was better for newly trained ADNs in nursing homes.

Applications for RN education programs have remained steady for the past several years, and most deans and directors indicated that their programs have filled to their respective capacities. The number of graduates from New York RN education programs has grown steadily over the past 10 years, but the production of new RNs is slowing in ADN programs, while increasing in BSN programs—especially BSN completer programs. Growth in the number of RN graduations is directly attributable to an increasing number of BSN completers, ie, already licensed RNs who go on to obtain a bachelor’s degree in nursing. In 2015, 21% of total RN graduates in New York were BSN completers. Although BSN completers do not represent new RN capacity, existing RNs who hold a BSN have increased opportunities for career advancement, and also qualify for further education to become nurse practitioners or nurse educators.

The job market for newly trained RNs appears to be more competitive in 2015 than in 2014, though that varies significantly by DOL region. Between 2014 and 2015, a larger percentage of deans and directors in most upstate DOL regions reported “many jobs” were available across all health care settings, particularly

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for newly trained BSNs. In contrast, a significantly lower percentage of deans and directors in New York City reported “many jobs” for newly trained RNs.

G. Demand for Workers CHWS, in conjunction with statewide and regional provider organizations, conducts annual surveys of human resources directors of FQHCs, home health agencies, hospitals, and nursing homes throughout New York. The surveys ask about the professions and occupations that pose the greatest recruitment and retention challenges. Respondents rated difficulty of recruitment and retention using a Likert scale, where 1 represented “not at all difficult” or “no turnover” and 5 indicated “extremely difficult” or “extreme turnover.” To conduct these surveys, CHWS collaborated with the following provider organizations:

• Community Health Center Association of New York State • Continuing Care Leadership Coalition at the Greater New York Hospital Association • Healthcare Association of New York State • Home Care Association of New York State, Inc. • LeadingAge New York • New York State Association of Healthcare Providers, Inc.

Findings from these surveys are reported statewide and by NYSDOL regions. In instances where total responses for a region by setting were less than 5, no information was provided or contiguous regions were combined.

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1. Hospitals In 2016, 108 hospitals statewide, or approximately 46%, responded to the survey. Hospitals reported the most difficulty recruiting clinical laboratory technologists, followed by psychiatric NPs and experienced RNs. Newly licensed RNs were the most difficult to retain (Table 14). Hospitals also reported recruitment and retention difficulties for primary care physicians, both in inpatient and outpatient settings.

Table 14. Recruitment and Retention Difficulties for Hospitals in Selected Health Occupations in New York, 2016 Average Assessment of Percentage of Respondents Difficulty Indicating Reasons for Difficulties Occupation Shortage Salary Geographic Recruitment Retention of Levels Location Workers Experienced Registered Nurses 3.8 2.9 63% 54% 65% Newly Licensed Registered Nurses 2.1 3.4 28% 25% 29% Nurse Managers 3.8 2.5 55% 20% 40% CNA/Patient Care Techs 2.3 2.8 26% 27% 17% Nurse Practitioners 3.6 2.4 56% 36% 45% Physician Assistants 3.5 2.5 54% 42% 47% Pharmacists 2.9 2.1 38% 18% 33% Clinical Lab Technicians 3.4 2.8 49% 31% 34% Clinical Lab Technologists 3.9 2.7 74% 43% 47% Medical Hospital Coders 3.7 2.8 61% 19% 12% Occupational Therapists 3.1 2.1 25% 17% 17% Care Coordinators 2.8 2.1 31% 5% 27% Case Managers 2.9 2.3 39% 12% 28% Care Managers 2.8 2.4 29% 4% 25% Patient Navigators 2.3 2.0 33% 5% 10% Community Health Workers 2.4 2.7 33% 8% 9% Psychologists 3.1 2.7 35% 27% 34% Psychiatric NPs 3.9 2.6 59% 31% 40% Licensed Clinical Social Workers 3.4 2.5 36% 12% 27% Licensed Master Social Workers 2.9 2.7 37% 15% 30% Licensed Mental Health Counselors 3.2 2.2 30% 12% 26%

• Many hospitals anticipated growth in inpatient services, with increasing demand for care coordinators (57%), CNAs (55%), and NPs (53%). • Many hospitals anticipated growth in outpatient services, with increasing demand for CNAs (62%), care coordinators (60%), and clinical lab technicians (55%).

2. Nursing Homes In 2016, 110 nursing homes in New York responded to the survey for a response rate of 17%. Nursing homes across the state reported the most difficulty recruiting experienced RNs, nurse managers, and

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MDS coordinators. Nursing homes also noted that CNAs were the most difficult to retain, followed by both experienced and newly licensed RNs, LPNs, and nurse managers (Table 15).

Table 15. Recruitment and Retention Difficulties for Nursing Homes in Selected Health Occupations in New York, 2016 Average Assessment of Percentage of Respondents Indicating Difficulty Reasons for Difficulties Occupation Shortage Salary Recruitment Retention of Benefits Location Levels Workers Activities Director 2.4 1.9 11% 8% 4% 9% Certified Nurse Aides (CNAs) 3.3 3.9 51% 31% 16% 28% Dietary Aides 2.6 3.0 18% 23% 5% 14% Dietitians/Nutritionists 3.0 2.4 15% 17% 3% 12% Housekeeping Staff 2.5 2.8 16% 17% 3% 17% Licensed Practical Nurses 3.5 3.5 46% 34% 15% 22% Medical Billers 2.8 2.4 21% 9% 2% 9% Occupational Therapists 3.2 2.6 32% 12% 4% 13% Occupational Therapy Assistants 3.0 2.5 25% 11% 3% 16% Physical Therapists 3.1 2.6 28% 14% 4% 18% Physical Therapist Assistants 2.9 2.5 23% 8% 3% 11% Registered Nurses (RNs) Newly Licensed RNs 3.4 3.1 37% 38% 19% 22% Experienced RNs 3.9 3.7 45% 36% 16% 24% MDS Coordinators 3.6 2.9 42% 22% 13% 14% Nurse Manager 3.9 3.4 44% 27% 13% 16% Director of Nursing 3.5 2.6 29% 19% 11% 16% Recreational Therapists 2.8 2.3 13% 15% 4% 9% Respiratory Therapists 2.9 2.4 33% 9% 3% 15% Social Workers (SWs) Licensed Clinical Social Workers 2.9 2.3 15% 11% 3% 11% Licensed Master Social Workers 2.8 2.4 18% 12% 5% 10% Speech-Language Pathologists 3.0 2.7 26% 12% 9% 12%

• Forty-five percent (45%) of nursing homes reported difficulty hiring part-time workers. • Six percent (6%) of nursing homes reported difficulty hiring bilingual workers. • Sixty-nine percent (69%) of nursing homes indicated difficulty hiring workers for off shifts (evenings, nights, and weekends). • About 15% of nursing homes projected expansion of services within the next year.

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3. Home Health Care Agencies

In 2016, 50 home health care agenciesl in New York responded to the survey for a response rate of about 18%. Home health care agencies reported the most difficulties recruiting speech-language pathologists, followed by occupational therapists and respiratory therapists. Survey respondents reported difficulty retaining homemakers and personal care aides (Table 16).

Table 16. Recruitment and Retention Difficulties for Home Health Care Agencies in Selected Health Occupations in New York, 2016 Average Assessment of Percentage of Respondents Indicating Reasons for Difficulty Difficulties Occupation Lack of Non-Competitive Recruitment Retention Shortage Specialized Location Salaries/Benefits Training Home Health Aides 3.4 3.6 50% 42% 19% 35% Homemakers 3.5 4.0 0% 50% 0% 33% Personal Care Aides 3.4 4.0 33% 44% 22% 44% Dietitians/Nutritionists 3.3 2.3 0% 0% 17% 17% Licensed Practical 2.6 2.3 8% 25% 17% 4% Nurses Occupational Therapists 4.1 3.0 0% 24% 24% 35% Physical Therapists 3.5 2.8 50% 30% 5% 25% Registered Nurses Newly Licensed RNs 3.0 3.1 22% 23% 23% 31% Experienced RNs 4.0 3.3 46% 43% 14% 29% Respiratory Therapists 4.1 3.2 43% 14% 14% 57% Social Workers (SWs) Licensed Clinical SWs 3.1 2.4 24% 12% 18% 12% Licensed Master SWs 2.9 2.4 26% 22% 15% 19% Speech-Language 4.3 3.5 80% 33% 20% 53% Pathologists

• Thirty-two percent (32%) of home health care agencies reported difficulty hiring part-time workers. • Twenty-seven percent (27%) of home health care agencies reported difficulty hiring bilingual workers. • Forty-two percent (42%) of home health care agencies indicated difficulty hiring workers for off- shifts (evenings, nights, and weekends). • Fifty-two percent (52%) of home health care agencies projected expansion of services.

l For purposes of this report, home health care agencies include certified home health agencies, long-term home health care programs, and hospice programs.

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4. Federally Qualified Health Centers Sixty-two percent (62%) of FQHCs statewide responded to the 2016 survey. Of these respondents, most had difficulty recruiting psychiatrists, psychiatric NPs, and family/general practice physicians, and they reported the most difficulty retaining psychiatric NPs, followed by other behavioral health practitioners (Table 17).

Table 17. Recruitment and Retention Difficulties for FQHCs in Selected Health Occupations in New York, 2016 Average Assessment of Difficulty Occupation Recruitment Retention Family/General Practice 4.2 2.9 Internal Medicine 4.1 3.0 Physicians Ob/Gyn 3.9 2.7 Pediatricians 3.5 2.6 Physician Assistants (PAs) 2.5 2.7 Overall – All Specialties 3.0 2.9 Pediatric 2.9 2.3 Nurse Practitioners Adult 2.6 2.4 Family 3.1 3.0 Psychiatric 4.3 3.7 Registered Nurses 3.6 2.8 Nurses Licensed Practical Nurses 3.1 2.7 Psychiatrists 4.4 3.1 Psychologists 3.5 3.2 Behavioral Health Substance Abuse Counselors 3.9 3.1 Social Workers 3.8 2.9 Dentists 3.7 3.1 Oral Health Dental Hygienists 2.8 2.5 Care Coordinators 3.2 2.8 Coordination/Patient Case Managers 2.8 2.6 Care HIV Counselors 2.8 2.5 Community Health Workers 2.3 2.2 Patient/Community Patient Health Educators 2.6 2.1 Education Nutritionists/Nutrition Educators 2.9 2.5 Patient Health Navigators 2.7 2.3 Outreach Workers 2.7 2.4 Enabling Services Transportation Workers 2.7 2.1 Interpreters 3.2 1.8 Administrative Support IT Systems Admin/Maintenance 3.0 2.5 Physical Therapists 3.0 2.3 Others Occupational Therapists 3.5 3.0

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H. Projected Job Growth Between 2014 and 2024, the NYSDOL projects more than 10,000 annual job openings (both new jobs and replacement of existing workers who leave) for home health aides in the state, more than 6,000 annual job openings for personal care aides, and over 7,000 annual job openings for RNs (Table 18).

Table 18. Employment Projections for Selected Health Occupations in New York, including New York City, 2014-2024 Change Between Average Annual Occupation 2014 2024 2014 and 2024 Openings Number Percent a Home Health Aides 161,970 235,310 73,340 45.3% 10,992 Personal Care Aides 164,700 215,950 51,250 31.1% 6,457 Registered Nurses 183,210 214,460 31,250 17.1% 7,447 Nursing Assistants 110,730 128,430 17,700 16.0% 4,271 Social Workers 60,530 70,330 9,800 16.2% 2,438 Licensed Practical and Licensed Vocational Nurses 51,550 60,870 9,320 18.1% 2,399 Medical Assistants 25,490 31,540 6,050 23.7% 1,136 Physical Therapists 16,740 21,650 4,910 29.3% 939 Emergency Medical Technicians and Paramedics 16,480 21,270 4,790 29.1% 749 Medical and Health Services Managers 31,580 35,520 3,940 12.5% 1,191 Dental Assistants 19,860 23,640 3,780 19.0% 869 Nurse Practitioners 11,420 15,080 3,660 32.0% 635 Physician Assistants 11,480 14,590 3,110 27.1% 569 Clinical, Counseling, and School Psychologists 15,450 18,130 2,680 17.3% 599 Speech-Language Pathologists 10,960 13,320 2,360 21.5% 512 Dental Hygienists 10,640 12,830 2,190 20.6% 395 Occupational Therapists 9,760 11,940 2,180 22.3% 407 Pharmacy Technicians 16,950 19,100 2,150 12.7% 383 Medical Records and Health Information Technicians 9,220 10,720 1,500 16.3% 356 Medical and Clinical Laboratory Technicians 8,830 10,280 1,450 16.4% 356 Diagnostic Medical Sonographers 5,270 6,660 1,390 26.4% 240 Radiologic Technologists 14,260 15,550 1,290 9.0% 398 Pharmacists 19,640 20,690 1,050 5.3% 563 Dietitians and Nutritionists 5,220 6,260 1,040 19.9% 143 Medical and Clinical Laboratory Technologists 10,420 11,410 990 9.5% 348 Orderlies 5,400 6,270 870 16.1% 209 Respiratory Therapists 6,410 7,100 690 10.8% 221 Surgical Technologists 5,510 6,180 670 12.2% 122 Cardiovascular Technologists and Technicians 3,050 3,680 630 20.7% 121 Psychiatric Aides 7,100 7,500 400 5.6% 200 Nurse Anesthetists 1,630 1,950 320 19.6% 70 Nurse Midwives 490 560 70 14.3% 19 aAnnual openings reflect creation of new positions in the occupation and replacement for those retiring or otherwise leaving the occupation. Source: New York State Department of Labor, Jobs in Demand/Projects, Long-Term Occupation Projections, 2012-2022.

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V. REGIONAL PROFILES

A. New York City The NYSDOL New York City region includes the 5 counties in New York City: Bronx, New York (Manhattan), Kings (Brooklyn), Queens, and Richmond (Staten Island).

Population

New York City’s population had a higher percentage of people under 100% and under 200% of the federal poverty level (FPL) than New York as a whole. New York City’s population was also much more racially and ethnically diverse. New York City also had a higher percentage of its population with less than a high school education or equivalent (Table 19).

Table 19. Selected Population Characteristics in the New York City Region, 2010-2014 (5-Year Average) Region Statewide Population Characteristicsa Number Percent Percent Total population 8,354,889 N/A N/A Population under 100% FPL 1,696,394 20.3% 15.2% Population under 200% FPL 3,327,324 39.8% 31.7% Population aged birth to 17 years 1,785,344 21.4% 21.8% Population aged 65 and older 1,046,671 12.5% 14.1% Population female aged 15 to 44 1,929,479 23.1% 20.7% Women aged 15 to 19 who had a birth in past 12 mos. 4,740 0.1% 0.05% Women aged 20 to 34 who had a birth in past 12 mos. 76,042 0.9% 0.8% Women aged 35 to 50 who had a birth in past 12 mos. 32,806 0.4% 0.3% Black/African American, non-Hispanic 1,886,662 22.6% 14.4% Hispanic/Latino 2,407,983 28.8% 18.2% Asian/Pacific Islander, non-Hispanic 1,101,324 13.2% 7.7% American Indian/Native Alaskan, non-Hispanic 15,951 0.2% 0.2% Two or more/other 207,887 2.5% 2.2% Less than high school education 1,140,654 19.9% 14.6% High school or equivalent 2,221,473 38.8% 43.2% Associate degree 359,327 6.3% 8.5% Bachelor's degree 1,183,696 20.7% 19.1% Master's degree or higher 818,446 14.3% 14.6% a Education levels and rates are based on individuals aged 25 years and older. Source: US Census, American Community Survey, 2010-2014 (5-Year Average)

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Health Status

New York City had a lower number of deaths per capita and a higher birth rate than statewide between 2011 and 2013. However, New York City had much higher rates of asthma (both adult and pediatric), diabetes, preventable hospitalizations, and chronic lower respiratory disease hospitalizations than the state as a whole. Additionally, New York City had a higher percentage of births with no or late prenatal care and a higher rate of both total hospitalizations and ED visits than statewide (Table 20).

Table 20. Selected Health Indicators in the New York City Region, 2011-2013 (3-Year Average) Region Statewide Health Indicator Number Rate Number Rate Total deaths, per 100,000 51,369 616.7 147,313 753.1 Deaths due to heart disease, per 100,000 16,630 199.7 43,448 222.1 Deaths due to all cancers, per 100,000 12,492 151.1 35,215 180.7 Deaths due to diabetes, per 100,000 1,777 21.3 3,975 20.3 Total births, per 1,000 females aged 15 to 44 117,841 61.4 238,078 59.0 Teen births, per 1,000 females aged 15 to 19 5,635 23.0 12,441 19.5 Low-birthweight births, as a percent of total births 9,857 8.4 19,006 8.0 Late/no prenatal care, as a percent of total births 8,303 7.1 13,148 5.6 Infant deaths, per 1,000 live births 512 4.3 1,179 5.0 Total hospitalizations, per 10,000 1,086,553 1,304.5 2,398,679 1,226.2 Preventable hospitalizations, per 10,000 135,320 162.5 293,493 150.0 Adult asthma hospitalizations, per 10,000 15,345 23.4 24,276 15.9 Pediatric asthma hospitalizations, per 10,000 7,827 43.9 11,340 26.6 Diabetes hospitalizations, per 10,000 20,344 24.4 37,847 19.3 CLRD hospitalizations, per 10,000 34,447 41.4 71,475 36.5 Heart disease hospitalizations, per 10,000 86,568 103.9 212,301 108.5 Total ED visits, per 10,000 3,778,598 4,536.6 7,993,838 4,086.4 Source: New York State Community Health Indicator Reports, 2011-2013 (3- Year Average)

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Primary Care Physicians

There were about 12,000 primary care physicians practicing in the New York City region in 2015. Slightly less than half of them (49%) practiced general internal medicine, and nearly 15% practiced general pediatrics. At 145.3 physicians per 100,000 children ages 0 - 17, general pediatricians were the most prevalent of the primary care specialties. There were over 3,000 psychiatrists, including child and adolescent psychiatrists, practicing in the New York City region, or approximately 43 per 100,000. The county of New York had the most family, general, and internal medicine practitioners per 100,000 total population (163.9), and Queens had the least (67.3) (Table 21 and Figure 18).

Table 21. Primary Care Physicians and Psychiatrists in the New York City Region, by Specialty, 2015 Per 100,000 Specialty Physicians Population a Family/General Practice 1,735 20.8 Internal Medicine (General) 5,746 68.8 Subtotal 7,481 89.6 Geriatrics 187 17.9 Obstetrics/Gynecology 1,444 74.8 Pediatrics (General) 2,595 145.3 Primary Care Total 11,707 N/A Psychiatrist 3,595 43.0 a All rates are per 100,000 total population except the Ob/Gyn rate, which is per 100,000 women aged 15 to 44, the pediatrician rate, which is per 100,000 children aged birth to 17 years, and the geriatrics rate, which is per 100,000 population aged 65 and older. Source: Center for Health Workforce Studies

Figure 18. Number of Selected Primary Care Physicians per 100,000 Population in the New York City Region, by County, 2015

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Employment

Total Health Sector Employment

Between 2001 and 2014, employment in the health sector in New York City grew steadily, with the largest increases occurring after 2006. Employment trends in all other sectors fluctuated, experiencing highs and lows. Between 2008 and 2009, employment in New York City in sectors outside of health care declined but has since recovered. Between 2001 and 2014 employment in the health sector in New York City rose by nearly 28%, while employment in all other sectors grew by about 8% during the same period (Figure 19).

Figure 19. Employment Growth in the New York City Region, 2000-2014 (Standardized to 2001)

125%

120%

115%

110% Health Care

105%

100%

95% All Other Sectors

90%

Source: New York State Department of Labor, ES-202

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Employment by Setting

Hospitals continued to be the largest employer of New York City health workers in 2014, accounting for 43% of all health care jobs. Ambulatory care settings and home health care agencies followed at 24% and 22%, respectively (Figure 20).

Figure 20. Health Sector Employment in the New York City Region, by Setting, 2014

Nursing Home and Personal Care facilities 10.5%

Ambulatory Care 24.2%

Hospitals 43.2% Home Health Care 22.1%

Source: New York State Department of Labor, ES-202

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Between 2010 and 2014, employment increased substantially in New York City in ambulatory care and home health care, while nursing homes lost jobs during the same period. Home health care jobs grew by more than 43% between 2010 and 2014. Ambulatory care settings and hospitals experienced job growth of 11% and 4% respectively, whereas the number of jobs in nursing homes declined by 7% (Figures 21 and 22).

Figure 21. Number of Health Care Jobs in the New York City Region by Setting, 2010-2014

250,000

209,677 200,675 200,000

150,000

117,446 105,439 107,005 100,000 74,711

54,439 50,742 50,000

0 Ambulatory Care Home Health Care Hospitals Nursing Home and Personal Care facilities 2010 2014

Source: New York State Department of Labor, ES-202

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Figure 22. Number of Health Care Jobs in the New York City Region, by Setting, 2010-2014

250,000

200,000

150,000

100,000

50,000

0 2010 2011 2012 2013 2014

Ambulatory Care Home Health Care

Hospitals Nursing Home and Personal Care facilities

Source: New York State Department of Labor, ES-202

Employment and Wage by Occupation

Employment for selected health occupations for the New York City region is reported in Table 22. As of the first quarter of 2015, home health aides had the largest share of jobs (117,760), followed by personal care aides (71,390) and RNs (70,990). Nurse anesthetists (440) and dietetic technicians (260) had the fewest jobs in the region.

Average wages per hour in selected health occupations for New York City are reported in Table 23. These wages are based on 2012-2015 survey data, which were adjusted to include the first quarter of 2016. Certified registered nurse anesthetists earned the highest hourly wage in 2016 ($76.00), followed by medical and health service managers ($67.16), NPs ($55.56), and pharmacists ($54.58). Personal care aides and home health aides were the lowest wage earners ($11.54 and $11.14, respectively).

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Table 22. Number of Jobs in Selected Health Occupations in the New York City Region, 2015 Occupation Employment Home Health Aides 117,760 Personal Care Aides 71,390 Registered Nurses 70,990 Nursing Assistants 40,910 Social Workers 26,450 Licensed Practical and Licensed Vocational Nurses 13,930 Medical and Health Services Managers 13,390 Medical Assistants 11,330 Pharmacists 8,080 Dental Assistants 8,000 Pharmacy Technicians 6,310 Physical Therapists 6,090 Radiologic Technologists and Technicians 5,110 Physician Assistants 4,820 Nurse Practitioners 4,590 Medical and Clinical Laboratory Technologists 4,220 Medical Secretaries 3,730 Occupational Therapists 3,240 Medical Records and Health Information Technicians 3,160 Medical and Clinical Laboratory Technicians 3,070 Surgical Technologists 2,650 Speech-Language Pathologists 2,460 Respiratory Therapists 2,460 Mental Health Counselors 2,440 Dental Hygienists 2,360 Orderlies 2,250 Dietitians and Nutritionists 1,830 Physical Therapist Aides 1,460 Physical Therapist Assistants 1,200 Cardiovascular Technologists and Technicians 1,180 Occupational Therapy Assistants 670 Nuclear Medicine Technologists 470 Nurse Anesthetists 440 Dietetic Technicians 260 Source: New York State Department of Labor, Bureau of Labor Statistics, Occupational Wages

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Table 23. Average Hourly Wage in Selected Health Occupations in the New York City Region, 2016 Average Wage Occupation per Hour Nurse Anesthetists $76.00 Medical and Health Services Managers $67.16 Nurse Practitioners $55.56 Pharmacists $54.48 Physician Assistants $50.35 Nurse Midwives $48.51 Physical Therapists $43.97 Speech-Language Pathologists $43.63 Registered Nurses $43.49 Occupational Therapists $41.77 Dental Hygienists $41.63 Nuclear Medicine Technologists $40.19 Respiratory Therapists $36.87 Radiologic Technologists and Technicians $35.00 Medical and Clinical Laboratory Technologists $33.71 Dietitians and Nutritionists $32.19 Occupational Therapy Assistants $29.76 Social Workers $28.65 Cardiovascular Technologists and Technicians $28.20 Physical Therapist Assistants $27.00 Surgical Technologists $26.96 Licensed Practical and Licensed Vocational Nurses $25.44 Medical and Clinical Laboratory Technicians $24.11 Medical Records and Health Information Technicians $23.21 Medical Secretaries $22.31 Mental Health Counselors $21.55 Dietetic Technicians $21.51 Orderlies $19.27 Nursing Assistants $18.00 Pharmacy Technicians $17.17 Medical Assistants $16.95 Dental Assistants $16.15 Occupational Therapy Aides $14.12 Physical Therapist Aides $12.72 Personal Care Aides $11.54 Home Health Aides $11.14 Source: New York State Department of Labor, Labor Statistics, Occupational Wages

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Licensed Health Professionals

NPs had the largest percentage increase of licensed health professionals, growing by nearly 47% between 2010 and 2014. During the same period, the number of licensed social workers increased by more than 3,000, or 17%, and the number of licensed RNs in New York City grew by over 5,000 or 9%. Many other health professions grew, including physical therapist assistants (29%), pharmacists (28%), and physician assistants (27%). Conversely, clinical laboratory technicians experienced a decrease of 16% (Table 24).

Table 24. Number of Licensed Individuals in Selected Health Occupations in the New York City Region, 2010-2014 Change Between Profession 2010 2011 2012 2013 2014 2010 and 2014 Number Percent Registered Nurses 58,980 59,559 61,393 63,947 64,326 5,346 9.1% Licensed Practical Nurses 14,201 14,588 14,792 15,207 15,495 1,294 9.1% Social Workers 18,353 19,175 19,874 20,987 21,531 3,178 17.3% Pharmacists 5,503 5,709 5,930 6,291 7,046 1,543 28.0% Physical Therapists 4,714 4,799 4,978 5,176 5,474 760 16.1% Nurse Practitioners 3,263 3,541 3,874 4,462 4,782 1,519 46.6% Speech-Language Pathologists 3,744 3,972 4,243 4,564 4,696 952 25.4% Clinical Laboratory 4,493 4,406 4,474 4,418 4,498 5 0.1% Technologists Physician Assistants 2,885 3,013 3,211 3,466 3,667 782 27.1% Occupational Therapists 2,771 2,911 3,067 3,207 3,376 605 21.8% Dental Hygienists 1,704 1,775 1,856 1,965 2,059 355 20.8% Respiratory Therapists 1,331 1,402 1,439 1,516 1,568 237 17.8% Physical Therapist Assistants 1,085 1,104 1,213 1,296 1,401 316 29.1% Dietitians/Nutritionists 1,477 1,489 1,564 1,642 1,663 186 12.6% Occupational Therapy 944 992 1,013 996 996 52 5.5% Assistants Clinical Laboratory Technicians 631 577 581 537 530 -101 -16.0% Source: New York State Education Department, Office of Professions

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Demand for Health Workers

Hospitals

Hospitals in New York City reported the most difficulty recruiting medical coders, licensed mental health counselors, and nurse managers. Medical coders and physician assistants were also the most difficult to retain (Table 25).

Table 25. Recruitment and Retention Difficulties for Hospitals in Selected Health Occupations in the New York City Region, 2016 Average Assessment of Percentage of Respondents Difficulty Indicating Reasons for Difficulties Occupation Shortage of Salary Geographic Recruitment Retention Workers Levels Location Experienced Registered Nurses 3.7 2.2 21% 36% 0% Newly Licensed Registered Nurses 1.6 2.7 21% 36% 7% Nurse Managers 3.9 2.5 21% 29% 0% CNA/Patient Care Techs 1.3 1.1 21% 7% 0% Nurse Practitioners 2.8 2.0 36% 29% 0% Physician Assistants 3.3 2.8 29% 21% 0% Pharmacists 3.2 1.9 29% 14% 7% Clinical Lab Technicians 2.9 2.3 21% 7% 0% Clinical Lab Technologists 3.2 2.6 50% 36% 7% Medical Hospital Coders 4.3 2.8 57% 29% 21% Occupational Therapists 2.8 2.0 36% 21% 0% Care Coordinators 2.8 2.3 29% 7% 0% Case Managers 2.8 2.3 29% 7% 0% Care Managers 2.8 2.3 29% 7% 0% Patient Navigators 2.1 1.8 29% 0% 7% Community Health Workers 2.1 1.8 29% 0% 7% Psychologists 2.6 2.0 29% 21% 7% Psychiatric NPs 3.4 2.0 50% 21% 7% Licensed Clinical Social Workers 3.7 2.5 29% 29% 0% Licensed Master Social Workers 2.9 2.2 29% 29% 0% Licensed Mental Health 4.0 2.0 29% 21% 0% Counselors

• Many hospitals projected growth in inpatient services, with increasing demand for care managers (36%), NPs (36%), and clinical lab technicians (36%). • Many hospitals projected growth in outpatient services, with increasing demand for medical coders (64%), RNs (64%), and care managers (50%).

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Nursing Homes

Nursing homes in New York City reported that experienced RNs were the most difficult to recruit, followed by MDS coordinators, LPNs, nurse managers, and directors of nursing. CNAs were the most difficult to retain, followed by experienced RNs and LPNs. The primary reasons for these difficulties were related to salary levels and shortages of workers (Table 26).

Table 26. Recruitment and Retention Difficulties for Nursing Homes in Selected Health Occupations in the New York City Region, 2016 Average Assessment of Percentage of Respondents Indicating Difficulty Reasons for Difficulties Occupation Shortage Salary Recruitment Retention of Benefits Location Levels Workers Activities Director 2.1 2.3 29% 43% 0% 0% Certified Nurse Aides/Assts. (CNAs) 2.9 3.9 55% 45% 27% 0% Dietary Aides 2.7 2.9 33% 33% 0% 0% Dietitians/Nutritionists 3.1 2.7 38% 50% 0% 13% Housekeeping Staff 2.4 2.5 33% 33% 0% 0% Licensed Practical Nurses 3.6 3.4 40% 40% 10% 0% Medical Billers 2.0 1.8 20% 60% 0% 0% Occupational Therapists 2.9 2.9 33% 44% 0% 11% Occupational Therapy Assistants 2.7 2.8 33% 33% 0% 11% Physical Therapists 2.9 2.8 33% 44% 0% 11% Physical Therapist Assistants 2.7 2.6 33% 33% 0% 11% Registered Nurses (RNs) Newly Licensed RNs 2.9 3.0 20% 50% 0% 10% Experienced RNs 3.8 3.8 30% 60% 0% 10% MDS Coordinators 3.6 2.9 33% 44% 0% 0% Nurse Manager 3.6 3.0 44% 44% 0% 11% Director of Nursing 3.6 2.8 43% 43% 0% 14% Recreational Therapists 3.0 2.1 38% 25% 0% 0% Respiratory Therapists 2.0 3.0 67% 67% 0% 0% Social Workers (SWs) Licensed Clinical SWs 3.2 2.4 29% 43% 0% 0% Licensed Master SWs 2.6 2.5 43% 43% 0% 0% Speech-Language Pathologists 2.7 2.7 43% 57% 0% 14%

• Twenty-seven percent (27%) of nursing homes reported difficulty hiring part-time workers. • Thirty-six percent (36%) of nursing homes reported difficulty hiring bilingual workers. • Fifty-five percent (55%) of nursing homes indicated difficulty hiring workers for off shifts (evenings, nights, and weekends).

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Home Health Care Agencies

Home health care agencies in New York City reported the most difficulty recruiting speech-language pathologists, followed by respiratory therapists and physical therapists. Homemakers, personal care aides, and speech-language pathologists were the most difficult to retain (Table 27).

Table 27. Recruitment and Retention Difficulties for Home Health Care Agencies in Selected Health Occupations in the New York City Region, 2016 Average Assessment of Percentage of Respondents Indicating Reasons for Difficulty Difficulties

Occupation Lack of Non-Competitive Recruitment Retention Shortage Specialized Location Salaries/Benefits Training

Home Health Aides 2.8 3.5 25% 25% 0% 50% Homemakers 3.5 4.0 50% 50% 0% 50% Personal Care Aides 2.0 4.0 0% 0% 0% 100% Dietitians/Nutritionists 2.0 1.5 0% 0% 0% 50% Licensed Practical 2.0 2.0 25% 0% 0% 25% Nurses Occupational 3.8 3.0 60% 20% 20% 40% Therapists Physical Therapists 4.0 3.4 60% 40% 0% 40% Registered Nurses Newly Licensed RNs 2.5 2.8 25% 0% 0% 50% Experienced RNs 3.7 3.1 71% 14% 0% 57% Respiratory Therapists 4.0 2.0 0% 0% 0% 100% Social Workers (SWs) Licensed Clinical SWs 3.0 3.0 50% 50% 0% 50% Licensed Master SWs 2.2 2.4 20% 40% 0% 60% Speech-Language 4.5 4.0 100% 50% 0% 75% Pathologists

• Fourteen percent (14%) of home health care agencies indicated difficulty hiring part-time workers. • Fourteen Percent (14%) of home health care agencies indicated difficulty hiring workers for off shifts (evenings, nights, and weekends). • Only one-fourth of home health care agencies in New York City expected to increase services within the next year.

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FQHCs

New York City and Long Island regions were combined due to low response rates. FQHCs in this region had the most difficulty recruiting and retaining physical therapists and occupational therapists, and physicians, psychiatrists, and psychiatric NPs were also difficult to recruit (Table 28).

Table 28. Recruitment and Retention Difficulties for FQHCs in Selected Health Occupations in the New York City and Long Island Region, 2016 Average Assessment of Difficulty Occupation Recruitment Retention Family/General Practice 4.2 2.7 Internal Medicine 4.1 2.8 Physicians Ob/Gyn 4.0 2.8 Pediatricians 3.3 3.0 Physician Assistants (PAs) 2.7 3.0 Overall – All Specialties 3.3 2.5 Pediatric 3.5 2.7 Nurse Practitioners Adult 3.1 2.5 Family 3.7 3.0 Psychiatric 4.4 3.0 Registered Nurses 3.9 3.3 Nurses Licensed Practical Nurses 3.5 2.8 Psychiatrists 4.6 3.3 Psychologists 4.2 4.0 Behavioral Health Substance Abuse Counselors 1.0 0.0 Social Workers 3.7 3.0 Dentists 3.4 2.3 Oral Health Dental Hygienists 2.8 2.6 Care Coordinators 3.3 3.2 Coordination/Patient Case Managers 3.3 3.2 Care HIV Counselors 2.2 2.0 Community Health Workers 2.4 2.7 Patient/Community Patient Health Educators 2.8 2.0 Education Nutritionists/Nutrition Educators 3.3 2.7 Patient Health Navigators 2.6 2.0 Outreach Workers 2.4 2.0 Enabling Services Transportation Workers 2.0 1.5 Interpreters 1.0 1.0 Administrative Support IT Systems Admin/Maintenance 3.2 3.0 Physical Therapists 5.0 5.0 Others Occupational Therapists 5.0 5.0

• Fifty-five percent (55%) of FQHCs in these regions identified difficulty hiring bilingual staff; Spanish is the language most needed. • Sixty-four percent (64%) of FQHCs in these regions anticipate expanding one or more service.

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Employment Projections by Health Occupation

According to the NYSDOL, the largest numbers of average annual job openings projected in New York City between 2012 and 2022 will be for home health aides (5,730), personal care aides (3,610), and RNs (2,260) (Table 29).

Table 29. Employment Projections for Selected Health Occupations in the New York City Region, 2012-2022 Change Between 2012 Average Occupation 2012 2022 and 2022 Annual Number Percent Openingsa Home Health Aides 81,960 123,670 41,710 50.9% 5,730 Personal Care Aides 77,130 107,720 30,590 39.7% 3,610 Registered Nurses 67,540 77,030 9,490 14.1% 2,260 Nursing Assistants 42,260 47,960 5,700 13.5% 1,370 Social Workers 27,360 31,040 3,680 13.5% 930 Licensed Practical and Licensed Vocational Nurses 14,310 17,150 2,840 19.8% 630 Medical Assistants 9,280 11,950 2,670 28.8% 450 Pharmacy Technicians 6,750 8,570 1,820 27.0% 250 Physical Therapists 6,020 7,740 1,720 28.6% 320 Pharmacists 8,680 10,290 1,610 18.5% 370 Medical and Health Services Managers 13,110 14,710 1,600 12.2% 480 Emergency Medical Technicians and Paramedics 6,900 8,180 1,280 18.6% 320 Dental Assistants 6,410 7,640 1,230 19.2% 250 Physician Assistants 3,630 4,690 1,060 29.2% 180 Nurse Practitioners 2,890 3,630 740 25.6% 140 Radiologic Technologists 4,180 4,910 730 17.5% 130 Occupational Therapists 3,110 3,770 660 21.2% 110 Medical and Clinical Laboratory Technicians 2,800 3,440 640 22.9% 130 Medical Records and Health Info Techs 3,740 4,350 610 16.3% 160 Diagnostic Medical Sonographers 1,310 1,850 540 41.2% 70 Dental Hygienists 2,020 2,540 520 25.7% 100 Speech-Language Pathologists 2,930 3,400 470 16.0% 90 Clinical, Counseling, and School Psychologists 5,450 5,910 460 8.4% 200 Medical and Clinical Laboratory Technologists 4,470 4,870 400 8.9% 160 Surgical Technologists 2,290 2,680 390 17.0% 60 Dietitians and Nutritionists 1,950 2,260 310 15.9% 50 Orderlies 1840 2150 310 16.8% 70 Respiratory Therapists 2,200 2,500 300 13.6% 60 Cardiovascular Technologists & Technicians 840 1,030 190 22.6% 30 Psychiatric Aides 3,010 3,200 190 6.3% 80 Nurse Anesthetists 490 580 90 18.4% 20 Nurse Midwives 280 320 40 14.3% 20

a Annual openings reflect creation of new positions in the occupation and replacement for those retiring or otherwise leaving the profession.

Source: New York State Department of Labor, Jobs in Demand/Projects, Long-Term Occupation Projections, 2012-2022

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B. Capital District

The Capital District region includes the counties of Albany, Columbia, Greene, Rensselaer, Saratoga, Schenectady, Warren, and Washington.

Population

The population of the Capital District region was less racially and ethnically diverse than New York as a whole and also had a lower percentage of people below 100% and 200% of the FPL. A higher percentage of individuals in the Capital District held high school diplomas or equivalents and associate degrees than statewide, while a lower percentage held bachelor’s degrees, and the percentage of individuals with a master’s degree or higher was comparable to the statewide rate (Table 30).

Table 30. Selected Population Characteristics in the Capital District Region, 2010-2014 (5-Year Average) Region Statewide Population Characteristicsa Number Percent Percent Total population 1,082,855 N/A N/A Population under 100% FPL 121,537 11.2% 15.2% Population under 200% FPL 272,388 25.2% 31.7% Population aged birth to 17 years 222,143 20.5% 21.8% Population aged 65 and older 167,044 15.4% 14.1% Population female aged 15 to 44 207,059 19.1% 20.7% Women aged 15 to 19 who had a birth in past 12 mos. 358 0.0% 0.05% Women aged 20 to 34 who had a birth in past 12 mos. 8,062 0.7% 0.8% Women aged 35 to 50 who had a birth in past 12 mos. 2,701 0.2% 0.3% Black/African American, non-Hispanic 70,039 6.5% 14.4% Hispanic/Latino 46,539 4.3% 18.2% Asian/Pacific Islander, non-Hispanic 33,489 3.1% 7.7% American Indian/Native Alaskan, non-Hispanic 1,583 0.1% 0.2% Two or more/other 26,750 2.5% 2.2% Less than high school education 64,973 8.7% 14.6% High school or equivalent 352,926 47.3% 43.2% Associate degree 85,930 11.5% 8.5% Bachelor's degree 132,831 17.8% 19.1% Master's degree or higher 109,357 14.7% 14.6% a Education levels and rates are based on individuals aged 25 years and older. Source: US Census, American Community Survey, 2010-2014 (5-Year Average)

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Health Status

The Capital District region had a higher total death rate and deaths due to all types of cancer than the state as a whole and upstate New York. The Capital District region had lower rates of asthma (both adult and pediatric) and diabetes hospitalizations compared with both the state as a whole and upstate New York. The rate for preventable hospitalizations was much lower in the Capital District region compared with the state as a whole and upstate New York (Table 31).

Table 31. Selected Health Indicators in the Capital District Region, 2011-2013 (3-Year Average) Region Statewide Upstate Health Indicator Number Rate Number Rate Number Rate Total deaths, per 100,000 9,696 895.9 95,944 854.1 147,313 753.1 Deaths due to heart disease, per 100,000 2,559 236.4 26,818 238.7 43,448 222.1 Deaths due to all cancers, per 100,000 2,386 220.7 22,723 202.4 35,215 180.7 Deaths due to diabetes, per 100,000 227 20.9 2,198 19.6 3,975 20.3 Total births, per 1,000 females aged 15 to 44 10,993 53.2 120,237 56.8 238,078 59.0 Teen births, per 1,000 females aged 15 to 19 675 18.5 6,806 17.3 12,441 19.5 Low-birthweight births, as a percent of total births 856 7.8 9,150 7.6 19,006 8.0 Late/no prenatal care, as a percent of total births 505 4.7 4,845 4.1 13,148 5.6 Infant deaths, per 1,000 live births 71 6.5 667 5.5 1,179 5.0 Total hospitalizations, per 10,000 118,625 1,096.1 1,312,126 1,168.1 2,398,679 1,226.2 Preventable hospitalizations, per 10,000 14,133 129.3 158,173 140.8 293,493 150.0 Adult asthma hospitalizations, per 10,000 761 8.8 8,931 10.2 24,276 15.9 Pediatric asthma hospitalizations, per 10,000 241 10.9 3,513 14.2 11,340 26.6 Diabetes hospitalizations, per 10,000 1,507 13.9 17,503 15.6 37,847 19.3 CLRD hospitalizations, per 10,000 3,669 33.9 37,028 33.0 71,475 36.5 Heart disease hospitalizations, per 10,000 10,100 93.3 125,733 111.9 212,301 108.5 Total ED visits, per 10,000 413,659 3,822.2 4,215,240 3,752.5 7,993,838 4,086.4 Source: New York State Community Health Indicator Reports, 2011-2013 (3- Year Average)

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Primary Care Physicians

There were nearly 1,300 primary care physicians practicing in the Capital District region in 2015. Over one- third (38%) of them were in family or general practice and 33% were in general internal medicine. There were over 200 psychiatrists, including child and adolescent psychiatrists, practicing in the Capital District region, or approximately 20.1 per 100,000. Warren County had the highest rate of physicians, with 110.8 per 100,000 total population, whereas Greene County had the lowest rate with 56.2 per 100,000 total population. Albany County also had a high rate of primary care physicians, with 110.7 per 100,000 total population (Table 32 and Figure 23).

Table 32. Primary Care Physicians and Psychiatrists in the Capital District Region, by Specialty, 2015 Per 100,000 Specialty Physicians Populationa Family/General Practice 488 45.1 Internal Medicine (General) 418 38.6 Subtotal 906 83.7 Geriatrics 4 2.5 Obstetrics/Gynecology 137 66.0 Pediatrics (General) 224 100.9 Primary Care Total 1,271 N/A Psychiatrist 217 20.1 a All rates are per 100,000 total population except the Ob/Gyn rate, which is per 100,000 women aged 15 to 44, the pediatrician rate, which is per 100,000 children aged birth to 17 years, and the geriatrics rate, which is per 100,000 population aged 65 and older. Source: Center for Health Workforce Studies

Figure 23. Number of Selected Primary Care Physicians per 100,000 Population in the Capital District Region, by County, 2015

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Employment

Total Health Sector Employment

Between 2010 and 2014, employment in the health care sector in the Capital District region grew by more than 2,700 jobs, or nearly 5%. Ambulatory care (11%), hospitals (2%), and home health (12%) contributed to this overall trend, while jobs in nursing home and personal care facilities (-0.2%) declined slightly (Table 33).

Table 33. Number of Health Care Jobs in the Capital District Region, by Setting, 2010-2014 Change Between Setting 2010 2011 2012 2013 2014 2010 and 2014 Number Percent Hospitals 23,057 23,541 23,796 23,902 23,522 465 2.0% Ambulatory care 17,222 17,461 17,735 18,284 19,118 1,896 11.0% (excluding home health) Nursing home and personal 11,194 11,240 11,413 11,132 11,167 -27 -0.2% care facilities Home health care 3,049 3,078 3,154 3,161 3,419 370 12.1% Total 54,521 55,320 56,098 56,459 57,226 2,705 5.0% Source: New York State Department of Labor, ES-202

Employment and Wage by Occupation

Employment for selected health occupations is reported in Table 34. RNs in the Capital District had the largest number of jobs in 2015 (11,180), followed by nursing assistants (6,750), personal care aides (6,660), and home health aides (4,210). Occupational therapy assistants (110) and nuclear medicine technologists (60) had the smallest number of jobs in the Capital District region.

Average wages per hour in selected health occupations for the Capital District are reported in Table 35. These wages were based on 2012-2015 survey data, which were adjusted to include the first quarter of 2016. Nurse anesthetists earned the highest hourly wage in 2016 ($71.82), followed by pharmacists and medical and health services managers ($58.13 and $49.65, respectively). Nursing assistants ($13.53), personal care aides ($12.96), and home health aides ($12.38) were the lowest wage earners.

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Table 34. Number of Jobs in Selected Health Occupations in the Capital District Region, 2015 Occupation Employment Registered Nurses 11,180 Nursing Assistants 6,750 Personal Care Aides 6,660 Home Health Aides 4,210 Licensed Practical and Licensed Vocational Nurses 3,680 Social Workers 3,140 Medical and Health Services Managers 1,720 Pharmacists 1,360 Pharmacy Technicians 1,250 Medical Assistants 1,140 Dental Assistants 1,010 Physical Therapists 840 Medical Secretaries 830 Radiologic Technologists and Technicians 770 Physician Assistants 730 Nurse Practitioners 690 Speech-Language Pathologists 690 Medical Records and Health Information Technicians 690 Dental Hygienists 670 Medical and Clinical Laboratory Technologists 670 Medical and Clinical Laboratory Technicians 570 Occupational Therapists 540 Mental Health Counselors 400 Respiratory Therapists 380 Dietitians and Nutritionists 320 Surgical Technologists 290 Physical Therapist Assistants 280 Orderlies 250 Cardiovascular Technologists and Technicians 200 Nurse Anesthetists 180 Occupational Therapy Assistants 110 Nuclear Medicine Technologists 60 Source: New York State Department of Labor, Bureau of Labor Statistics, Occupational Wages

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Table 35. Average Hourly Wage in Selected Health Occupations in the Capital District Region, 2016 Average Wage Occupation per Hour Nurse Anesthetists $71.82 Pharmacists $58.13 Medical and Health Services Managers $49.65 Nurse Practitioners $49.45 Physician Assistants $46.11 Nuclear Medicine Technologists $39.70 Physical Therapists $35.92 Occupational Therapists $34.67 Speech-Language Pathologists $32.07 Dental Hygienists $30.95 Registered Nurses $30.33 Medical and Clinical Laboratory Technologists $29.54 Dietitians and Nutritionists $29.40 Respiratory Therapists $29.07 Social Workers $27.96 Radiologic Technologists and Technicians $27.90 Cardiovascular Technologists and Technicians $27.57 Occupational Therapy Assistants $23.43 Physical Therapist Assistants $22.08 Licensed Practical and Licensed Vocational Nurses $20.90 Dietetic Technicians $19.26 Medical and Clinical Laboratory Technicians $19.10 Surgical Technologists $18.84 Mental Health Counselors $18.58 Dental Assistants $17.82 Medical Secretaries $17.24 Occupational Therapy Aides $17.12 Medical Records and Health Information Technicians $17.04 Medical Assistants $16.03 Pharmacy Technicians $15.25 Orderlies $15.10 Physical Therapist Aides $13.54 Nursing Assistants $13.53 Personal Care Aides $12.96 Home Health Aides $12.38 Source: New York State Department of Labor, Labor Statistics, Occupational Wages

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Licensed Health Professionals

Between 2010 and 2014, the Capital District experienced a large increase in the number of licensed RNs— more than 680, or about 4%. This was followed by smaller increases in LPNs (390), social workers (230), NPs (188), and PAs (167). The licensed professions with the largest percentage increases in the Capital District during that period included PAs (28%), NPs (27%), and occupational therapists (13%).

Table 36. Number of Licensed Individuals in Selected Health Occupations in the Capital District Region, 2010-2014 Change Between Profession 2010 2011 2012 2013 2014 2010 and 2014 Number Percent Registered Nurses 15,513 15,506 15,643 16,276 16,199 686 4.4% Licensed Practical Nurses 5,064 5,245 5,269 5,355 5,454 390 7.7% Social Workers 2,320 2,415 2,450 2,515 2,550 230 9.9% Pharmacists 1,431 1,444 1,487 1,546 1,541 110 7.7% Physical Therapists 1,011 1,019 1,050 1,087 1,082 71 7.0% Nurse Practitioners 704 716 748 831 892 188 26.7% Speech-Language Pathologists 892 912 913 939 950 58 6.5% Clinical Laboratory Technologists 924 876 854 826 837 -87 -9.4% Physician Assistants 593 612 643 680 760 167 28.2% Occupational Therapists 539 547 578 591 607 68 12.6% Dental Hygienists 821 849 855 874 873 52 6.3% Respiratory Therapists 360 370 377 390 400 40 11.1% Physical Therapist Assistants 355 339 337 333 320 -35 -9.9% Dietitians/Nutritionists 300 294 303 313 332 32 10.7% Occupational Therapy Assistants 292 308 309 307 305 13 4.5% Clinical Laboratory Technicians 130 115 109 98 98 -32 -24.6%

Source: New York State Education Department, Office of Professions

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Demand for Health Workers

Hospitals

Hospitals in the Capital District region reported the most difficulty recruiting experienced RNs, psychologists, and psychiatric NPs. Other occupations identified as difficult to recruit included NPs, PAs, nurse managers, medical coders, case managers, and clinical lab technologists and technicians. CNAs/patient care technicians were the most difficult to retain, followed by nurse practitioners, physician assistants, and licensed master social workers.

Table 37. Recruitment and Retention Difficulties for Hospitals in Selected Health Occupations in the Capital District Region, 2016 Average Assessment of Percentage of Respondents Difficulty Indicating Reasons for Difficulties Occupation Shortage Salary Geographic Recruitment Retention of Workers Levels Location Experienced Registered Nurses 4.8 3.0 75% 25% 0% Newly Licensed Registered Nurses 2.5 4.0 100% 75% 0% Nurse Managers 3.8 2.3 0% 0% 0% CNA/Patient Care Technicians 3.3 4.8 75% 75% 0% Nurse Practitioners 4.0 4.0 0% 25% 0% Physician Assistants 4.0 4.0 75% 25% 75% Pharmacists 3.0 2.3 0% 0% 0% Clinical Lab Technicians 3.5 3.0 25% 0% 0% Clinical Lab Technologists 3.5 3.3 25% 0% 0% Medical Hospital Coders 3.8 3.0 75% 75% 0% Occupational Therapists 1.5 1.5 0% 0% 0% Care Coordinators 3.0 3.0 0% 0% 0% Case Managers 3.8 3.0 75% 75% 0% Care Managers 3.0 3.0 0% 0% 0% Patient Navigators 3.0 3.0 0% 0% 0% Community Health Workers 3.0 3.8 75% 75% 0% Psychologists 4.8 3.8 75% 0% 25% Psychiatric NPs 4.8 3.0 75% 0% 0% Licensed Clinical Social Workers 3.0 3.3 0% 0% 0% Licensed Master Social Workers 3.0 4.0 75% 0% 0% Licensed Mental Health Counselors 3.0 3.0 0% 0% 0%

• Many hospitals projected growth in inpatient services, with increasing demand for NPs (100%), RNs (100%), and CNA (100%). • Many hospitals projected growth in outpatient services, with increasing demand for NPs (100%), RNs (100%), and PAs (100%).

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Nursing Homes

Nursing homes in the Capital District region reported that in 2016 experienced RNs were the most difficult to recruit. CNAs were the most difficult to retain, followed by speech-language pathologists. Likewise, experienced RNs, MDS coordinators, and nurse managers were also difficult to retain (Table 38).

Table 38. Recruitment and Retention Difficulties for Nursing Homes in Selected Health Occupations in the Capital District Region, 2016 Average Assessment of Percentage of Respondents Indicating Difficulty Reasons for Difficulties Occupation Shortage Salary Recruitment Retention of Benefits Location Levels Workers Activities Director 3.0 2.3 13% 13% 0% 11% Certified Nurse Aides/Assts. (CNAs) 3.9 3.8 78% 11% 11% 22% Dietary Aides 2.4 2.6 13% 13% 0% 13% Dietitians/Nutritionists 3.8 2.8 20% 20% 0% 0% Housekeeping Staff 2.2 2.8 11% 11% 0% 11% Licensed Practical Nurses 3.1 2.6 33% 22% 11% 11% Medical Billers 2.5 2.3 0% 0% 0% 0% Occupational Therapists 3.3 2.3 0% 0% 0% 0% Occupational Therapy Assistants 3.3 2.3 0% 0% 0% 0% Physical Therapists 2.8 2.3 0% 0% 0% 0% Physical Therapist Assistants 3.3 2.3 0% 0% 0% 0% Registered Nurses (RNs) Newly Licensed RNs 3.1 3.0 38% 25% 13% 13% Experienced RNs 4.1 3.7 44% 44% 11% 11% MDS Coordinators 3.4 3.2 25% 13% 0% 13% Nurse Manager 3.4 3.0 22% 0% 0% 11% Director of Nursing 3.6 2.0 29% 14% 0% 14% Recreational Therapists 1.3 2.0 0% 0% 0% 0% Respiratory Therapists N/A N/A N/A N/A N/A N/A Social Workers (SWs) Licensed Clinical SWs 3.0 2.7 0% 25% 0% 25% Licensed Master SWs 3.0 1.8 17% 0% 17% 17% Speech-Language Pathologists 4.0 2.0 0% 0% 0% 0%

• Fifty-six percent (56%) reported difficulty hiring part-time workers. • Eleven percent (11%) reported difficulty hiring bilingual workers. • Seventy-eight percent (78%) indicated difficulty hiring workers for off shifts (evenings, nights, and weekends).

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Home Health Care Agencies

Home health care agencies in the Capital District region reported the greatest difficulty recruiting respiratory therapists and homemakers, followed by occupational therapists. These agencies also reported that home health aides and personal care aides were the most difficult to retain (Table 39).

Table 39. Recruitment and Retention Difficulties for Home Health Care Agencies in Selected Health Occupations in the Capital District, 2016 Average Assessment of Percentage of Respondents Indicating Reasons for Difficulty Difficulties

Occupation Lack of Non-Competitive Recruitment Retention Shortage Specialized Location Salaries/Benefits Training

Home Health Aides 3.7 3.3 0% 33% 33% 67% Homemakers 5.0 2.0 0% 0% 0% 0% Personal Care Aides 3.7 3.3 0% 33% 33% 33% Dietitians/Nutritionists 4.0 2.5 0% 0% 0% 0% Licensed Practical 2.7 2.3 0% 33% 33% 0% Nurses Occupational 4.7 2.7 0% 33% 33% 0% Therapists Physical Therapists 4.0 2.7 67% 33% 0% 33% Registered Nurses Newly Licensed RNs 3.0 3.0 0% 0% 0% 0% Experienced RNs 4.3 3.0 50% 50% 25% 25% Respiratory Therapists 5.0 N/A 100% 0% 0% 0% Social Workers Licensed Clinical SWs 3.0 2.0 0% 0% 0% 0% Licensed Master SWs 3.8 2.8 50% 0% 0% 0% Speech-Language 4.0 3.0 50% 0% 0% 0% Pathologists

• Twenty percent (20%) of home health care agencies reported difficulty hiring part-time workers and hiring bilingual workers. • Forty percent (40%) of home health care agencies indicated difficulty hiring workers for off shifts (evenings, nights, and weekends). • More than half of home health care agencies in the Capital District projected expanding services within the next year.

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FQHCs

Hudson Valley and Capital District regions were combined due to low survey response rates. FQHCs in this region had the most difficulty recruiting family/general practice physicians Ob/Gyns and LPNs. FQHCs reported the most difficulty retaining IT support and RNs (Table 40).

Table 40. Recruitment and Retention Difficulties for FQHCs in Selected Health Occupations in the Capital District and Hudson Valley Regions, 2016 Average Assessment of Difficulty Occupation Recruitment Retention Family/General Practice 3.8 2.2 Internal Medicine 3.6 2.2 Physicians Ob/Gyn 3.8 2.6 Pediatricians 2.5 2.2 Physician Assistants (PAs) 2.2 2.6 Overall – All Specialties 2.6 2.6 Pediatric 2.5 2.3 Nurse Practitioners Adult 2.3 2.3 Family 2.6 2.6 Psychiatric 2.8 2.7 Registered 3.3 2.8 Nurses Licensed Practical Nurses 3.8 2.7 Psychiatrists 3.3 2.3 Psychologists 2.7 3.0 Behavioral Health Substance Abuse Counselors 2.5 2.7 Social Workers 2.8 2.3 Dentists 2.8 2.3 Oral Health Dental Hygienists 2.5 2.3 Care Coordinators 3.3 2.7 Coordination/Patient Case Managers 2.0 2.3 Care HIV Counselors 1.0 1.0 Community Health Workers 1.0 1.0 Patient/Community Patient Health Educators 1.0 1.0 Education Nutritionists/Nutrition Educators 2.3 2.3 Patient Health Navigators 1.0 1.0 Outreach Workers 1.0 1.0 Enabling Services Transportation Workers 1.0 1.0 Interpreters 1.0 1.0 Administrative IT Systems Admin/Maintenance 3.5 2.8 Support Physical Therapists 3.0 1.0 Others Occupational Therapists 2.0 1.0 • Sixty percent (60%) of FQHCs in these regions indicated difficulty hiring bilingual staff; Spanish was the language most needed. • Eighty percent (80%) of FQHCs in these regions indicated anticipation for expanding one or more service.

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Employment Projections by Health Occupation

According to the NYSDOL, the largest numbers of average annual job openings projected in the Capital District between 2012 and 2022 will be for RNs (390), home health aides (260), personal care aides (210), and nursing assistants (210) (Table 41).

Table 41. Employment Projections for Selected Health Occupations in the Capital District Region, 2012-2022

Change Between 2012 Average Occupation 2012 2022 and 2022 Annual Openingsa Number Percent Personal Care Aides 5,550 7,230 1,680 30.3% 210 Home Health Aides 5,090 6,690 1,600 31.4% 260 Registered Nurses 12,010 13,590 1,580 13.2% 390 Nursing Assistants 6,290 7,230 940 14.9% 210 Licensed Practical and Licensed Vocational Nurses 3,980 4,750 770 19.3% 180 Social Workers 3,880 4,370 490 12.6% 140 Emergency Medical Technicians and Paramedics 1,400 1,860 460 32.9% 90 Pharmacy Technicians 1,090 1,350 260 23.9% 40 Medical Assistants 1,010 1,270 260 25.7% 50 Physician Assistants 620 840 220 35.5% 30 Nurse Practitioners 670 880 210 31.3% 30 Physical Therapists 820 1,020 200 24.4% 40 Dental Hygienists 850 1,040 190 22.4% 40 Medical and Health Services Managers 1,810 1,980 170 9.4% 60 Medical and Clinical Laboratory Technicians 730 900 170 23.3% 40 Speech-Language Pathologists 850 1,010 160 18.8% 30 Pharmacists 990 1,130 140 14.1% 30 Medical Records and Health Info Techs 580 710 130 22.4% 30 Dental Assistants 900 1,030 130 14.4% 30 Radiologic Technologists 800 920 120 15.0% 20 Occupational Therapists 510 610 100 19.6% 20 Diagnostic Medical Sonographers 250 350 100 40.0% 10 Surgical Technologists 340 420 80 23.5% 10 Clinical, Counseling, and School Psychologists 820 890 70 8.5% 30 Dietitians and Nutritionists 300 350 50 16.7% 0 Respiratory Therapists 340 390 50 14.7% 20 Medical and Clinical Laboratory Technologists 630 680 50 7.9% 20 Cardiovascular Technologists & Technicians 200 240 40 20.0% 10 Nurse Anesthetists 190 220 30 15.8% 0 Psychiatric Aides 400 430 30 7.5% 10 Orderlies 150 170 20 13.3% 0 aAnnual openings reflect creation of new positions in the occupation and replacement for those retiring or otherwise leaving the profession. Source: New York State Department of Labor, Jobs in Demand/Projects, Long-Term Occupation Projections, 2012-2022

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C. Central New York The Central New York region includes the counties of Cayuga, Cortland, Madison, Onondaga, and Oswego.

Population

The distribution of the population in the Central New York region by age roughly matched the state’s distribution, including the percentage of females of child-bearing age (ages 15 to 44). However, the Central New York region was substantially less racially and ethnically diverse than the state as a whole and had a higher percentage of individuals with high school diplomas or equivalents and a higher percentage of individuals with associate degrees compared to the state as a whole (Table 42).

Table 42. Selected Population Characteristics in the Central New York Region, 2010-2014 (5-Year Average) Region Statewide Population Characteristicsa Number Percent Percent Total population 790,948 N/A N/A Population under 100% FPL 113,183 14.3% 15.2% Population under 200% FPL 240,252 30.4% 31.7% Population aged birth to 17 years 173,535 21.9% 21.8% Population aged 65 and older 115,300 14.6% 14.1% Population female aged 15 to 44 156,493 19.8% 20.7% Women aged 15 to 19 who had a birth in past 12 mos. 558 0.1% 0.05% Women aged 20 to 34 who had a birth in past 12 mos. 7,116 0.9% 0.8% Women aged 35 to 50 who had a birth in past 12 mos. 1,706 0.2% 0.3% Black/African American, non-Hispanic 55,949 7.1% 14.4% Hispanic/Latino 27,675 3.5% 18.2% Asian/Pacific Islander, non-Hispanic 18,345 2.3% 7.7% American Indian/Native Alaskan, non-Hispanic 3,824 0.5% 0.2% Two or more/other 17,045 2.2% 2.2% Less than high school education 56,993 10.8% 14.6% High school or equivalent 256,129 48.8% 43.2% Associate degree 62,870 12.0% 8.5% Bachelor's degree 83,837 16.0% 19.1% Master's degree or higher 65,544 12.5% 14.6% a Education levels and rates are based on individuals aged 25 years and older. Source: US Census, American Community Survey, 2010-2014 (5-Year Average)

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Health Status

The Central New York region had a higher overall total death rate and deaths due to all cancers than the state as a whole and upstate New York. The overall birth rate was lower in Central New York than in the state and upstate New York but the teen birth rate was higher. The Central New York region also had lower rates of asthma (both adult and pediatric), heart disease hospitalizations, ED visits, and total hospitalizations compared to the state as a whole and upstate New York, but had a similar rate of preventable hospitalizations to New York State, and slightly a higher rate than Upstate overall (Table 43).

Table 43. Selected Health Indicators in the Central New York Region, 2011-2013 (3-Year Average) Region Upstate Statewide Health Indicator Number Rate Number Rate Number Rate Total deaths, per 100,000 6,920 875.3 147,313 753.1 147,313 753.1 Deaths due to heart disease, per 100,000 1,584 200.3 43,448 222.1 43,448 222.1 Deaths due to all cancers, per 100,000 1,702 215.1 35,215 180.7 35,215 180.7 Deaths due to diabetes, per 100,000 163 20.6 3,975 20.3 3,975 20.3 Total births, per 1,000 females aged 15 to 44 8,596 55.0 238,078 59.0 238,078 59.0 Teen births, per 1,000 females aged 15 to 19 716 22.9 12,441 19.5 12,441 19.5 Low-birthweight births, as a percent of total births 621 7.2 19,006 8.0 19,006 8.0 Late/no prenatal care, as a percent of total births 303 3.5 13,148 5.6 13,148 5.6 Infant deaths, per 1,000 live births 50 5.9 1,179 5.0 1,179 5.0 Total hospitalizations, per 10,000 89,502 1,132.0 2,398,679 1,226.2 2,398,679 1,226.2 Preventable hospitalizations, per 10,000 11,989 151.6 293,493 150.0 293,493 150.0 Adult asthma hospitalizations, per 10,000 437 7.1 24,276 15.9 24,276 15.9 Pediatric asthma hospitalizations, per 10,000 141 8.1 11,340 26.6 11,340 26.6 Diabetes hospitalizations, per 10,000 1,216 15.4 37,847 19.3 37,847 19.3 CLRD hospitalizations, per 10,000 2,482 31.4 71,475 36.5 71,475 36.5 Heart disease hospitalizations, per 10,000 8,494 107.4 212,301 108.5 212,301 108.5 Total ED visits, per 10,000 279,104 3,530.0 7,993,838 4.086.4 7,993,838 4,086.4 Source: New York State Community Health Indicator Reports, 2011-2013 (3- Year Average)

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Primary Care Physicians

There were nearly 900 primary care physicians practicing in the Central New York region. Thirty-nine percent (39%) were in family or general practice, 29% were in general internal medicine, and another 19% were in general pediatrics. There were over 100 psychiatrists per 100,000 total population, including child and adolescent psychiatrists, practicing in the Central New York region, or approximately 17.3 per 100,000. Onondaga County had the most family, general, and internal medicine (general) physicians per capita, with 85.0 per 100,000 total population, whereas Cayuga County had the fewest, with 49.9 per 100,000 (Table 44 and Figure 24).

Table 44. Primary Care Physicians and Psychiatrists in the Central New York Region, by Specialty, 2015 Per 100,000 Specialty Physicians Populationa Family/General Practice 338 42.7 Internal Medicine (General) 257 32.5 Subtotal 595 75.2 Geriatrics 8 7.1 Obstetrics/Gynecology 105 67.3 Pediatrics (General) 167 96.1 Primary Care Total 875 N/A Psychiatrist 137 17.3 a All rates are per 100,000 total population except the Ob/Gyn rate, which is per 100,000 women aged 15 to 44, the pediatrician rate, which is per 100,000 children aged birth to 17 years, and the geriatrics rate, which is per 100,000 population aged 65 and older. Source: Center for Health Workforce Studies

Figure 24. Number of Selected Primary Care Physicians per 100,000 Population in the Central New York Region, by County, 2015

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Employment

Total Health Sector Employment

Between 2010 and 2014, health sector employment in the Central New York region grew by over 2,000 jobs, or over 5%. Employment in home health care grew by more than 730 jobs, or 53%, while jobs in nursing home and personal care facilities declined by over 550 jobs, or 6%, during the same period. Hospitals added more than 580 jobs between 2010 and 2014, growing by over 4%, while ambulatory care increased by more than 1,250 positions, or 9% (Table 45).

Table 45. Number of Health Care Jobs in the Central New York Region, by Setting, 2010-2014 Change Between Setting 2010 2011 2012 2013 2014 2010 and 2014 Number Percent Hospitals 13,133 13,202 13,781 13,869 13,715 582 4.4% Ambulatory care 13,414 13,644 14,125 14,337 14,677 1263 9.4% (excluding home health) Nursing home and personal 9,142 8,929 8,765 8,623 8,589 -553 -6.1% care facilities Home health care 1,404 1,593 1,829 2,112 2,142 738 52.6% Total 37,093 37,367 38,500 38,941 39,123 2,030 5.5% Source: New York State Department of Labor, ES-202

Employment and Wage by Occupation

Employment for selected health occupations for the Central New York region is reported in Table 46. RNs in the Central New York region had the most jobs in the first quarter of 2015 (6,130), followed by personal care aides (4,720) and nursing assistants (3,880). Physical therapist aides, nuclear medicine technologists, and dietetic technicians had the fewest jobs (80, 50, and 50, respectively).

Wages in selected health occupations for Central New York are reported in Table 47. These wages are based on 2012-2015 survey data, which were adjusted to include the first quarter of 2016. Certified registered nurse anesthetists earned the highest hourly wage in 2016 ($72.79), followed by pharmacists and medical and health service managers ($61.36 and $52.46, respectively). The lowest wage earners for the Central New York region were home health aides ($12.58), personal care aides ($12.25), and orderlies ($12.24).

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Table 46. Number of Jobs in Selected Health Occupations in the Central New York Region, 2015 Occupation Employment Registered Nurses 6,130 Personal Care Aides 4,720 Nursing Assistants 3,880 Licensed Practical and Licensed Vocational Nurses 2,580 Home Health Aides 2,040 Social Workers 1,830 Medical and Health Services Managers 870 Medical Secretaries 860 Medical Assistants 730 Radiologic Technologists and Technicians 710 Pharmacy Technicians 690 Pharmacists 660 Physical Therapists 630 Dental Hygienists 630 Dental Assistants 630 Nurse Practitioners 570 Physician Assistants 510 Medical and Clinical Laboratory Technologists 480 Medical Records and Health Information Technicians 430 Speech-Language Pathologists 400 Occupational Therapists 340 Mental Health Counselors 330 Physical Therapist Assistants 240 Surgical Technologists 210 Respiratory Therapists 190 Dietitians and Nutritionists 190 Cardiovascular Technologists and Technicians 100 Occupational Therapy Assistants 90 Physical Therapist Aides 80 Nuclear Medicine Technologists 50 Dietetic Technicians 50 Source: New York State Department of Labor, Bureau of Labor Statistics, Occupational Wages

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Table 47. Average Hourly Wage in Selected Health Occupations in the Central New York Region, 2016 Average Wage per Occupation Hour Nurse Anesthetists $72.79 Pharmacists $61.36 Medical and Health Services Managers $52.46 Physician Assistants $50.19 Nurse Practitioners $47.28 Nurse Midwives $38.64 Nuclear Medicine Technologists $37.93 Physical Therapists $36.34 Speech-Language Pathologists $32.80 Occupational Therapists $32.60 Dental Hygienists $32.06 Registered Nurses $29.51 Dietitians and Nutritionists $28.89 Respiratory Therapists $28.56 Radiologic Technologists and Technicians $28.34 Cardiovascular Technologists and Technicians $28.29 Medical and Clinical Laboratory Technologists $26.98 Social Workers $25.49 Surgical Technologists $24.19 Medical and Clinical Laboratory Technicians $23.96 Occupational Therapy Assistants $23.45 Physical Therapist Assistants $21.56 Dietetic Technicians $20.98 Medical Records and Health Information Technicians $19.37 Mental Health Counselors $18.94 Licensed Practical and Licensed Vocational Nurses $18.65 Dental Assistants $16.83 Occupational Therapy Aides $15.65 Physical Therapist Aides $15.60 Medical Secretaries $15.38 Medical Assistants $14.72 Pharmacy Technicians $13.80 Nursing Assistants $13.38 Home Health Aides $12.58 Personal Care Aides $12.25 Orderlies $12.24 Source: New York State Department of Labor, Labor Statistics, Occupational Wages

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Licensed Health Professionals

Between 2010 and 2014 in Central New York, the number of licensed registered nurses increased by over 800, more than any other licensed health profession. During the same period, there were 230 more social workers, an increase of 19%. Additionally, physician assistants saw the highest percentage increase in numbers (44.3%), while the number of occupational therapy assistants declined by over 3% (Table 48).

Table 48. Number of Licensed Individuals in Selected Health Occupations in the Central New York Region, 2010-2014 Change Between Profession 2010 2011 2012 2013 2014 2010 and 2014 Number Percent Registered Nurses 10,785 10,935 11,197 11,606 11,601 816 7.6% Licensed Practical Nurses 5,046 5,177 5,130 5,136 5,178 132 2.6% Social Workers 1,217 1,263 1,323 1,397 1,451 234 19.2% Pharmacists 708 714 746 794 789 81 11.4% Physical Therapists 724 721 735 784 792 68 9.4% Nurse Practitioners 959 992 1,018 1,124 1,173 214 22.3% Speech-Language Pathologists 471 489 512 522 534 63 13.4% Clinical Laboratory Technologists 564 558 561 555 598 34 6.0% Physician Assistants 370 405 436 462 534 164 44.3% Occupational Therapists 307 298 315 347 364 57 18.6% Dental Hygienists 548 563 563 558 568 20 3.6% Respiratory Therapists 342 353 355 373 386 44 12.9% Physical Therapist Assistants 235 241 255 264 269 34 14.5% Dietitians/Nutritionists 187 183 192 204 201 14 7.5% Occupational Therapy Assistants 97 95 103 99 94 -3 -3.1% Clinical Laboratory Technicians 123 110 128 126 129 6 4.9% Source: New York State Education Department, Office of Professions

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Demand for Health Workers

Hospitals

Hospitals in the Central New York region reported the most difficulty recruiting psychiatric NPs, followed by experienced registered nurses, psychologists, and licensed mental health counselors. They had the most difficulty retaining newly licensed RNs, physician assistants, psychiatric NPs, and psychologists (Table 49).

Table 49. Recruitment and Retention Difficulties for Hospitals in Selected Health Occupations in the Central New York Region, 2016 Average Assessment of Percentage of Respondents Difficulty Indicating Reasons for Difficulties Occupation Shortage Salary Geographic Recruitment Retention of Levels Location Workers Experienced Registered Nurses 3.8 2.6 33% 33% 83% Newly Licensed Registered Nurses 1.6 3.0 17% 33% 50% Nurse Managers 3.2 2.2 33% 33% 17% CNA/Patient Care Techs 1.0 1.3 0% 0% 0% Nurse Practitioners 3.4 2.3 67% 17% 33% Physician Assistants 3.0 3.0 50% 17% 33% Pharmacists 2.4 2.0 17% 33% 17% Clinical Lab Technicians 2.6 2.5 33% 17% 0% Clinical Lab Technologists 2.8 2.5 33% 17% 0% Medical Hospital Coders 3.0 2.0 33% 17% 0% Occupational Therapists 2.4 2.0 33% 17% 17% Care Coordinators 2.0 1.3 17% 0% 17% Case Managers 3.0 1.5 33% 0% 17% Care Managers 2.3 1.3 17% 0% 17% Patient Navigators 2.6 1.3 33% 0% 17% Community Health Workers 3.0 1.3 33% 17% 33% Psychologists 3.8 2.8 50% 17% 33% Psychiatric NPs 4.0 3.0 67% 33% 33% Licensed Clinical Social Workers 3.4 1.3 33% 0% 0% Licensed Master Social Workers 3.0 2.3 17% 0% 0% Licensed Mental Health Counselors 3.7 2.3 17% 0% 0%

• Many hospitals projected growth in inpatient services, with increasing demand for NPs (67%), medical assistant (50%), and CNA (50%). • Many hospitals projected growth in outpatient services, with increasing demand for care coordinator (67%), RNs (50%), and CNA (50%).

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Nursing Homes

In the Central New York region, nursing homes reported that MDS coordinators, nurse managers, and directors of nursing were the most difficult to recruit. LPNs were the most difficult occupation to retain for nursing homes in the Central New York region, followed by housekeeping staff, nurse managers, and CNAs (Table 50).

Table 50. Recruitment and Retention Difficulties for Nursing Homes in Selected Health Occupations in the Central New York Region, 2016 Average Assessment of Percentage of Respondents Indicating Difficulty Reasons for Difficulties Occupation Shortage Salary Recruitment Retention of Benefits Location Levels Workers Activities Director 2.8 2.0 0% 0% 0% 0% Certified Nurse Aides/Assts. (CNAs) 3.5 4.0 67% 0% 0% 33% Dietary Aides 2.6 3.5 0% 20% 0% 0% Dietitians/Nutritionists 2.8 2.7 0% 0% 0% 0% Housekeeping Staff 3.2 4.2 0% 17% 0% 33% Licensed Practical Nurses 4.2 4.4 50% 0% 0% 33% Medical Billers 2.6 2.3 20% 0% 0% 0% Occupational Therapists 4.0 3.3 50% 0% 0% 0% Occupational Therapy Assistants 3.5 3.0 25% 0% 0% 0% Physical Therapists 4.0 3.0 25% 25% 0% 0% Physical Therapist Assistants 3.8 3.3 50% 25% 0% 0% Registered Nurses (RNs) Newly Licensed RNs 4.3 3.0 0% 0% 0% 33% Experienced RNs 4.2 3.8 33% 0% 0% 17% MDS Coordinators 4.5 3.0 25% 0% 0% 0% Nurse Manager 4.5 4.2 50% 0% 0% 17% Director of Nursing 4.4 3.3 60% 0% 0% 20% Recreational Therapists 2.5 2.7 0% 0% 0% 0% Respiratory Therapists 3.5 2.0 25% 0% 0% 0% Social Workers (SWs) Licensed Clinical SWs 3.8 2.3 25% 0% 0% 0% Licensed Master SWs 3.8 2.7 25% 0% 0% 0% Speech-Language Pathologists 3.3 2.5 25% 0% 0% 0%

• Thirty-three percent (33%) of nursing homes reported difficulty hiring part-time workers. • All respondents indicated difficulty hiring workers for off shifts (evenings, nights, and weekends).

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Home Health Care Agencies

Responses rates to recruitment and retention surveys were too low in the Central New York and Mohawk Valley regions to report individually, so responses were combined. Home health care agencies in these two regions reported the most difficulty recruiting homemakers, followed by occupational therapists and personal care aides. Similarly, survey respondents reported difficulties retaining personal care aides (Table 51).

Table 51. Recruitment and Retention Difficulties for Home Health Care Agencies in Selected Health Occupations in the Central New York and Mohawk Valley Regions, 2016 Average Assessment of Percentage of Respondents Indicating Reasons Difficulty for Difficulties Non- Occupation Lack of Competitive Recruitment Retention Shortage Specialized Location Salaries/ Training Benefits Home Health Aides 3.4 3.0 0% 20% 0% 40% Homemakers 5.0 2.0 0% 0% 0% 0% Personal Care Aides 4.0 3.3 0% 33% 0% 33% Dietitians/Nutritionists 3.5 2.0 0% 0% 0% 0% Licensed Practical Nurses 2.4 2.0 0% 20% 0% 0% Occupational Therapists 4.5 2.0 0% 50% 0% 0% Physical Therapists 3.0 2.0 50% 50% 0% 50% Registered Nurses Newly Licensed RNs 3.3 3.0 0% 0% 0% 0% Experienced RNs 3.7 3.0 17% 33% 17% 17% Respiratory Therapists N/A N/A N/A N/A N/A N/A Social Workers (SWs) Licensed Clinical SWs 2.0 2.0 0% 0% 0% 0% Licensed Master SWs 3.0 2.5 20% 0% 0% 0% Speech-Language Pathologists N/A N/A N/A N/A N/A N/A

• Two-thirds (67%) of home health care agencies indicated difficulty hiring workers for off shifts (evenings, nights, and weekends). • One-third (33%) of home health care agencies indicated difficulty hiring part-time workers. • Two-thirds of home health care agencies indicated they would be expanding services within the next year.

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FQHCs FQHCs in the Central New York region had the most difficulty recruiting psychiatric NPs, psychiatrists, and substance abuse counselors. FQHCs in the region had the most difficulty retaining psychiatric NPs and dentists (Table 52).

Table 52. Recruitment and Retention Difficulties for FQHCs in Selected Health Occupations in the Central New York Region, 2016 Average Assessment of Difficulty Occupation Recruitment Retention Family/General Practice 4.0 3.5 Internal Medicine 3.7 4.0 Physicians Ob/Gyn 3.0 3.0 Pediatricians 3.5 3.0 Physician Assistants (PAs) 2.7 3.0 Overall – All Specialties 2.3 3.3 Pediatric 2.0 4.0 Nurse Practitioners Adult 2.0 4.0 Family 2.8 3.3 Psychiatric 5.0 5.0 Registered Nurses 4.0 2.0 Nurses Licensed Practical Nurses 2.7 2.0 Psychiatrists 5.0 0.0 Psychologists 0.0 0.0 Behavioral Health Substance Abuse Counselors 5.0 3.0 Social Workers 4.5 3.0 Dentists 4.0 5.0 Oral Health Dental Hygienists 3.0 3.0 Care Coordinators 3.0 3.0 Coordination/Patient Case Managers 3.0 3.0 Care HIV Counselors 3.0 3.0 Community Health Workers 3.0 2.5 Patient/Community Patient Health Educators 3.0 2.5 Education Nutritionists/Nutrition Educators 2.5 2.0 Patient Health Navigators 3.0 3.0 Outreach Workers 3.0 3.0 Enabling Services Transportation Workers 4.0 2.0 Interpreters 3.5 3.0 Administrative Support IT Systems Admin/Maintenance 4.0 3.0 Physical Therapists 0.0 0.0 Others Occupational Therapists 0.0 0.0

• Eighty percent (80%) of FQHCs in this region indicated plans to expand services.

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Employment Projections by Health Occupation

According to the NYSDOL, the largest numbers of average annual job openings projected in the Central New York region between 2012 and 2022 will be for RNs (220), personal care aides (150), and LPNs (140). Over this same period, the region is expected to experience the largest percentage increase in employment for home health aides (31%) and physician assistants (31%), followed by dental hygienists (23%) and emergency medical technicians and paramedics (23%) (Table 53).

Table 53. Employment Projections for Selected Health Occupations in the Central New York Region, 2012-2022 Change Between Average Occupation 2012 2022 2012 and 2022 Annual Number Percent Openingsa Personal Care Aides 4,880 5,940 1,060 21.7% 150 Registered Nurses 7,780 8,450 670 8.6% 220 Home Health Aides 2,140 2,810 670 31.3% 110 Licensed Practical and Licensed Vocational Nurses 3,460 4,020 560 16.2% 140 Nursing Assistants 4,330 4,640 310 7.2% 110 Medical Assistants 950 1,160 210 22.1% 40 Social Workers 2,240 2,430 190 8.5% 80 Physician Assistants 480 630 150 31.3% 20 Emergency Medical Technicians and Paramedics 660 810 150 22.7% 40 Physical Therapists 790 920 130 16.5% 30 Dental Hygienists 480 590 110 22.9% 20 Dental Assistants 710 820 110 15.5% 30 Nurse Practitioners 470 570 100 21.3% 20 Pharmacy Technicians 780 870 90 11.5% 20 Medical and Health Services Managers 800 880 80 10.0% 30 Medical and Clinical Laboratory Technologists 620 700 80 12.9% 30 Radiologic Technologists 600 670 70 11.7% 20 Medical Records and Health Info Techs 490 560 70 14.3% 20 Speech-Language Pathologists 420 460 40 9.5% 10 Medical and Clinical Laboratory Technicians 200 240 40 20.0% 10 Clinical, Counseling, and School Psychologists 520 550 30 5.8% 10 Occupational Therapists 360 390 30 8.3% 10 Respiratory Therapists 340 370 30 8.8% 10 Diagnostic Medical Sonographers 150 180 30 20.0% 0 Surgical Technologists 290 320 30 10.3% 0 Pharmacists 750 770 20 2.7% 20 Dietitians and Nutritionists 200 210 10 5.0% 0 Nurse Anesthetists 50 60 10 20.0% 0 a Annual openings reflect creation of new positions in the occupation and replacement for those retiring or otherwise leaving the profession. Source: New York State Department of Labor, Jobs in Demand/Projects, Long-Term Occupation Projections, 2012-2022

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D. Finger Lakes The Finger Lakes region includes the counties of Genesee, Livingston, Monroe, Ontario, Orleans, Seneca, Wayne, Wyoming, and Yates.

Population

The population of the Finger Lakes region had a lower percentage of individuals below 100% and 200% of the FPL compared to the statewide average, was slightly older than the population of the state as a whole, and was also less racially and ethnically diverse. The region also had a higher percentage of individuals with high school or equivalent degrees and associate degrees, but had a lower percentage of individuals with bachelor’s degrees and of those with master’s degrees or higher compared to the state as a whole (Table 54).

Table 54. Selected Population Characteristics in the Finger Lakes Region, 2010-2014 (5-Year Average) Region Statewide Population Characteristicsa Number Percent Percent Total population 1,219,191 N/A N/A Population under 100% FPL 167,603 13.7% 15.2% Population under 200% FPL 363,551 29.8% 31.7% Population aged birth to 17 years 264,352 21.7% 21.8% Population aged 65 and older 184,082 15.1% 14.1% Population female aged 15 to 44 234,537 19.2% 20.7% Women aged 15 to 19 who had a birth in past 12 mos. 606 0.0% 0.05% Women aged 20 to 34 who had a birth in past 12 mos. 10,565 0.9% 0.8% Women aged 35 to 50 who had a birth in past 12 mos. 2,835 0.2% 0.3% Black/African American, non-Hispanic 123,203 10.1% 14.4% Hispanic/Latino 73,950 6.1% 18.2% Asian/Pacific Islander, non-Hispanic 29,903 2.5% 7.7% American Indian/Native Alaskan, non-Hispanic 2,837 0.2% 0.2% Two or more/other 23,565 1.9% 2.2% Less than high school education 86,454 10.5% 14.6% High school or equivalent 385,238 46.7% 43.2% Associate degree 98,990 12.0% 8.5% Bachelor's degree 143,130 17.4% 19.1% Master's degree or higher 110,650 13.4% 14.6% a Education levels and rates are based on individuals aged 25 years and older. Source: US Census, American Community Survey, 2010-2014 (5-Year Average)

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Health Status

The Finger Lakes region had higher rates of total deaths, deaths due to all cancers, and infant deaths than the state as a whole or upstate New York. While the total birth rate in the Finger Lakes region was lower than the state as a whole or Upstate York, the teen birth rate in the Finger Lakes region was higher than those two corresponding benchmarks.

The rates of preventable hospitalizations, ED visits, and total hospitalizations were lower in the Finger Lakes region than either the state as a whole or upstate. The Finger Lakes region also had lower rates of pediatric and adult asthma, chronic lower respiratory disease, and heart disease hospitalizations than the state as a whole and upstate (Table 55).

Table 55. Selected Health Indicators in the Finger Lakes Region, 2011-2013 (3-Year Average) Region Upstate Statewide Health Indicator Number Rate Number Rate Number Rate Total deaths, per 100,000 10,752 882.1 95,944 854.1 147,313 753.1 Deaths due to heart disease, per 100,000 2,538 208.2 26,818 238.7 43,448 222.1 Deaths due to all cancers, per 100,000 2,521 206.9 22,723 202.4 35,215 180.7 Deaths due to diabetes, per 100,000 223 18.3 2,198 19.6 3,975 20.3 Total births, per 1,000 females aged 15 to 44 12,975 55.3 120,237 56.8 238,078 59.0 Teen births, per 1,000 females aged 15 to 19 867 20.1 6,806 17.3 12,441 19.5 Low-birthweight births, as a percent of total births 997 7.7 9,150 7.6 19,006 8.0 Late/no prenatal care, as a percent of total births 476 3.9 4,845 4.1 13,148 5.6 Infant deaths, per 1,000 live births 85 6.5 667 5.5 1,179 5.0 Total hospitalizations, per 10,000 133,904 1,098.5 1,312,126 1,168.1 2,398,679 1,226.2 Preventable hospitalizations, per 10,000 16,885 138.5 158,173 140.8 293,493 150.0 Adult asthma hospitalizations, per 10,000 877 8.8 8,931 10.2 24,276 15.9 Pediatric asthma hospitalizations, per 10,000 22 11.9 3,513 14.2 11,340 26.6 Diabetes hospitalizations, per 10,000 1,932 15.8 17,503 15.6 37,847 19.3 CLRD hospitalizations, per 10,000 3,342 27.4 37,028 33.0 71,475 36.5 Heart disease hospitalizations, per 10,000 12,973 106.4 125,733 111.9 212,301 108.5 Total ED visits, per 10,000 441,465 3,621.5 4,215,240 3,752.5 7,993,838 4,086.4 Source: New York State Community Health Indicator Reports, 2011-2013 (3- Year Average)

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Primary Care Physicians

There were over 1,500 primary care physicians practicing in the Finger Lakes region in 2015. Forty percent (40%) were in general internal medicine, 26% were in family or general practice, and another 20% were in general pediatrics. There were more than 200 psychiatrists, including child and adolescent psychiatrists, practicing in the Finger Lakes region, or approximately 18.5 per 100,000. Monroe County had the highest rate with 99.0 of family, general, and internal medicine (general) physicians per 100,000 total population, and Orleans County had the lowest rate with 32.2 per 100,000 total population (Table 56 and Figure 25).

Table 56. Primary Care Physicians and Psychiatrists in the Finger Lakes Region, by Specialty, 2015 Per 100,000 Specialty Physicians Populationa Family/General Practice 402 33.0 Internal Medicine (General) 626 51.4 Subtotal 1,028 84.4 Geriatrics 41 22.3 Obstetrics/Gynecology 176 75.2 Pediatrics (General) 302 114.3 Primary Care Total 1,547 N/A Psychiatrist 226 18.5 a All rates are per 100,000 total population except the Ob/Gyn rate, which is per 100,000 women aged 15 to 44, the pediatrician rate, which is per 100,000 children aged birth to 17 years, and the geriatrics rate, which is per 100,000 population aged 65 and older. Source: Center for Health Workforce Studies

Figure 25. Number of Selected Primary Care Physicians per 100,000 Population in the Finger Lakes Region, by County, 2015

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Employment

Total Health Sector Employment

Between 2010 and 2014, health sector employment throughout the Finger Lakes region grew by nearly 3,800 jobs, or by over 6%. Employment in hospitals increased by over 2,100 jobs, or 8% and employment in ambulatory care settings grew by over 1,000 jobs, or 6%, during the same period. Home health care had the lowest percentage increase in jobs (3%) between 2010 and 2014, adding the least number of jobs (116) (Table 57).

Table 57. Number of Health Care Jobs in the Finger Lakes Region, by Setting, 2010-2014 Change Between Setting 2010 2011 2012 2013 2014 2010 and 2014 Number Percent Hospitals 28,258 28,916 29,436 29,546 30,406 2,148 7.6% Ambulatory care 16,457 16,505 16,538 17,225 17,497 1,040 6.3% (excluding home health) Nursing home and personal 12,811 12,746 12,817 13,059 13,299 488 3.8% care facilities Home health care 3,473 3,722 3,732 3,527 3,589 116 3.3% Total 60,999 61,889 62,523 63,357 64,791 3,792 6.2% Source: New York State Department of Labor, ES-202

Employment and Wage by Occupation

Employment for selected health occupations is reported in Table 58. RNs accounted for the most jobs in the Finger Lakes region in the first quarter of 2015 (11,810), followed by personal care aides (7,870) and nursing assistants (6,490). Dietetic technicians, nuclear medicine technologists, and nurse anesthetists had the fewest jobs (100, 70, and 60, respectively) in the region.

Wages in selected health occupations for the Finger Lakes region are reported in Table 59. These wages were based on 2012-2015 survey data, which were adjusted to include the first quarter of 2016. Certified registered nurse anesthetists earned the highest hourly wage in 2016 ($83.25), followed by pharmacists and medical and health services managers ($56.51 and $50.54, respectively). Orderlies ($12.91), personal care aides ($12.58), and home health aides ($12.43) were the lowest wage earners in the selected health occupations reported for the Finger Lakes region.

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Table 58. Number of Jobs in Selected Health Occupations in the Finger Lakes Region, 2015 Occupation Employment Registered Nurses 11,810 Personal Care Aides 7,870 Nursing Assistants 6,490 Home Health Aides 4,620 Licensed Practical and Licensed Vocational Nurses 3,890 Social Workers 3,260 Medical and Health Services Managers 1,320 Medical Secretaries 1,310 Pharmacy Technicians 1,140 Dental Hygienists 1,120 Physical Therapists 1,090 Nurse Practitioners 1,080 Dental Assistants 1,070 Medical Assistants 1,020 Pharmacists 990 Radiologic Technologists and Technicians 940 Physician Assistants 900 Speech-Language Pathologists 850 Medical and Clinical Laboratory Technologists 840 Occupational Therapists 720 Medical and Clinical Laboratory Technicians 720 Medical Records and Health Information Technicians 520 Respiratory Therapists 450 Mental Health Counselors 360 Physical Therapist Assistants 340 Dietitians and Nutritionists 300 Surgical Technologists 300 Orderlies 280 Occupational Therapy Assistants 160 Physical Therapist Aides 140 Cardiovascular Technologists and Technicians 120 Dietetic Technicians 100 Nuclear Medicine Technologists 70 Nurse Anesthetists 60 Source: New York State Department of Labor, Bureau of Labor Statistics, Occupational Wages

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Table 59. Average Hourly Wage in Selected Health Occupations in the Finger Lakes Region, 2016 Average Wage Occupation per Hour Nurse Anesthetists $83.25 Pharmacists $56.51 Medical and Health Services Managers $50.54 Nurse Midwives $49.59 Physician Assistants $47.53 Nurse Practitioners $44.42 Physical Therapists $37.76 Occupational Therapists $36.10 Nuclear Medicine Technologists $34.28 Speech-Language Pathologists $31.55 Registered Nurses $29.92 Dental Hygienists $29.80 Medical and Clinical Laboratory Technologists $28.37 Dietitians and Nutritionists $27.75 Respiratory Therapists $26.38 Cardiovascular Technologists and Technicians $26.38 Radiologic Technologists and Technicians $25.60 Social Workers $24.11 Occupational Therapy Assistants $23.91 Physical Therapist Assistants $22.83 Mental Health Counselors $19.94 Surgical Technologists $19.34 Licensed Practical and Licensed Vocational Nurses $19.33 Medical Records and Health Information Technicians $18.64 Dental Assistants $17.74 Medical and Clinical Laboratory Technicians $17.71 Medical Secretaries $15.25 Medical Assistants $14.83 Dietetic Technicians $14.57 Pharmacy Technicians $13.57 Nursing Assistants $13.49 Physical Therapist Aides $13.16 Orderlies $12.91 Personal Care Aides $12.58 Home Health Aides $12.43 Source: New York State Department of Labor, Labor Statistics, Occupational Wages

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Licensed Health Professionals

Between 2010 and 2014, the number of licensed RNs in the Finger Lakes region increased by nearly 1,400, or 9%. Additionally, over 300 (15%) social workers and more than 280 (5%) LPNs were added to the region. PAs had the largest percentage increase (26%), followed by respiratory therapists (21%), pharmacists (19%), physical therapist assistants (18%), and nurse practitioners (17%). Whereas the majority of selected licensed health professionals increased, 3 occupations experienced losses—occupational therapy assistants (-10%), clinical laboratory technicians (-3%), and clinical laboratory technologists (-2%) (Table 60).

Table 60. Number of Licensed Individuals in Selected Health Occupations in the Finger Lakes Region, 2010-2014 Change Between Profession 2010 2011 2012 2013 2014 2010 and 2014 Number Percent Registered Nurses 15,502 15,704 16,195 16,883 16,893 1,391 9.0% Licensed Practical Nurses 6,191 6,395 6,342 6,395 6,474 283 4.6% Social Workers 2,110 2,199 2,291 2,374 2,434 324 15.4% Pharmacists 1,036 1,071 1,121 1,172 1,233 197 19.0% Physical Therapists 967 990 1,006 1,056 1,085 118 12.2% Nurse Practitioners 1,365 1,413 1,451 1,538 1,593 228 16.7% Speech-Language Pathologists 978 1,022 1,037 1,070 1,079 101 10.3% Clinical Laboratory Technologists 960 939 950 935 941 -19 -2.0% Physician Assistants 625 642 686 733 789 164 26.2% Occupational Therapists 601 614 635 663 682 81 13.5% Dental Hygienists 1,032 1,049 1,041 1,059 1,089 57 5.5% Respiratory Therapists 285 305 318 331 346 61 21.4% Physical Therapist Assistants 279 287 299 310 330 51 18.3% Dietitians/Nutritionists 256 247 265 269 269 13 5.1% Occupational Therapy Assistants 226 222 222 213 203 -23 -10.2% Clinical Laboratory Technicians 71 65 64 70 69 -2 -2.8% Source: New York State Education Department, Office of Professions

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Demand for Health Workers

Hospitals

Hospitals in the Finger Lakes region reported the most difficulty recruiting clinical lab technologists, followed by psychiatric NPs, experienced registered nurses, nurse managers, and clinical laboratory technicians. Hospitals also reported the greatest retention difficulty for patient care technicians/CNAs, newly licensed RNs, experienced RNs, and nurse managers (Table 61).

Table 61. Recruitment and Retention Difficulties for Hospitals in Selected Health Occupations in the Finger Lakes Region, 2016 Percentage of Respondents Average Assessment of Indicating Reasons for Difficulty Difficulties Occupation Shortage Salary Geographic Recruitment Retention of Levels Location Workers Experienced Registered Nurses 3.7 3.0 57% 71% 57% Newly Licensed Registered Nurses 2.3 3.6 43% 71% 43% Nurse Managers 3.7 3.0 43% 43% 43% CNA/Patient Care Techs 2.7 3.9 43% 57% 14% Nurse Practitioners 3.6 2.7 71% 29% 29% Physician Assistants 3.6 2.6 57% 29% 43% Pharmacists 1.8 1.4 14% 14% 0% Clinical Lab Technicians 3.6 2.9 71% 43% 43% Clinical Lab Technologists 4.1 2.9 71% 43% 43% Medical Hospital Coders 3.1 2.7 43% 29% 29% Occupational Therapists 3.3 2.9 57% 71% 29% Care Coordinators 2.0 1.8 0% 0% 0% Case Managers 2.7 1.9 29% 29% 0% Care Managers 2.2 2.0 0% 0% 0% Patient Navigators 2.2 2.0 14% 14% 0% Community Health Workers 2.0 1.8 14% 14% 0% Psychologists 2.7 2.3 0% 0% 0% Psychiatric NPs 4.0 2.0 57% 14% 43% Licensed Clinical Social Workers 3.0 2.5 14% 14% 29% Licensed Master Social Workers 3.0 2.4 29% 43% 57% Licensed Mental Health Counselors 3.0 2.5 0% 14% 14%

• Many hospitals projected growth in inpatient services, with increasing demand for NPs (57%), RNs (43%), and CNAs (71%).

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• Many hospitals projected growth in outpatient services, with increasing demand for NPs (71%), RNs (57%), and CNAs (71%).

Nursing Homes

Nursing homes in the Finger Lakes region reported recruiting difficulties for experienced RNs, LPNs, MDS coordinators, and nurse managers. Nursing homes in the region also reported the most difficulty retaining CNAs, experienced RNs, LPNs, and nurse managers (Table 62).

Table 62. Recruitment and Retention Difficulties for Nursing Homes in Selected Health Occupations in the Finger Lakes Region, 2016 Average Assessment of Percentage of Respondents Indicating Difficulty Reasons for Difficulties Occupation Shortage Salary Recruitment Retention of Benefits Location Levels Workers Activities Director 2.3 1.8 7% 0% 0% 7% Certified Nurse Aides/Assts. (CNAs) 3.6 4.0 36% 36% 18% 23% Dietary Aides 2.9 3.4 25% 10% 5% 15% Dietitians/Nutritionists 2.9 2.1 0% 11% 0% 6% Housekeeping Staff 2.2 2.7 9% 14% 5% 9% Licensed Practical Nurses 3.9 3.7 57% 35% 13% 22% Medical Billers 3.4 2.8 33% 0% 0% 17% Occupational Therapists 2.7 2.1 12% 0% 0% 0% Occupational Therapy Assistants 2.8 2.2 12% 0% 0% 0% Physical Therapists 2.7 2.2 12% 0% 0% 12% Physical Therapist Assistants 2.5 2.2 13% 0% 0% 0% Registered Nurses (RNs) Newly Licensed RNs 3.6 3.5 25% 38% 25% 13% Experienced RNs 4.0 3.8 36% 32% 18% 14% MDS Coordinators 3.9 3.1 56% 25% 25% 13% Nurse Manager 3.9 3.7 35% 35% 22% 13% Director of Nursing 3.8 2.6 21% 16% 16% 0% Recreational Therapists 2.9 2.0 0% 0% 0% 0% Respiratory Therapists 3.3 2.8 25% 0% 0% 25% Social Workers (SWs) Licensed Clinical SWs 2.8 2.2 7% 0% 7% 7% Licensed Master SWs 2.8 1.9 8% 0% 0% 8% Speech-Language Pathologists 2.8 2.5 0% 0% 8% 0%

• Fifty-seven percent (57%) reported difficulty hiring part-time workers. • Four percent (4%) reported difficulty hiring bilingual workers. • Seventy-eight percent (78%) indicated difficulty hiring workers for off shifts (evenings, nights, and weekends).

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Home Health Care Agencies

Responses to the recruitment and retention survey from home health care agencies in the Finger Lakes region were too low in number for an adequate analysis, so responses were combined with those from the Western New York region for this study. Home health care agencies in these combined regions indicated the most difficulty recruiting homemakers and speech-language pathologists. Home health aides were the most difficult to retain, followed by personal care aides, and speech-language pathologists (Table 63).

Table 63. Recruitment and Retention Difficulties for Home Health Care Agencies in Selected Health Occupations in the Finger Lakes and Western New York Regions, 2016 Average Assessment of Percentage of Respondents Indicating Reasons Difficulty for Difficulties Non- Occupation Lack of Competitive Recruitment Retention Shortage Specialized Location Salaries/ Training Benefits Home Health Aides 3.2 3.5 33% 17% 17% 33%

Homemakers 5.0 2.0 0% 0% 0% 0%

Personal Care Aides 4.0 3.0 0% 0% 0% 50%

Dietitians/Nutritionists 3.7 2.3 0% 0% 67% 0%

Licensed Practical Nurses 1.8 2.0 0% 25% 0% 0%

Occupational Therapists 4.0 2.0 0% 100% 0% 0%

Physical Therapists 3.0 2.0 67% 33% 0% 33%

Registered Nurses Newly Licensed RNs 2.0 2.0 0% 0% 0% 0%

Experienced RNs 3.2 2.8 17% 67% 17% 17%

Respiratory Therapists N/A N/A N/A N/A N/A N/A

Social Workers (SWs) Licensed Clinical SWs 2.8 2.0 25% 25% 0% 0%

Licensed Master SWs 2.8 2.0 50% 17% 0% 0% Speech-Language Pathologists 5.0 3.0 100% 0% 0% 0%

• Seventeen percent (17%) of home health care agencies reported difficulty hiring part-time workers and hiring bilingual workers. • Fifty percent (50%) of home health care agencies indicated difficulty hiring workers for off shifts (evenings, nights, and weekends). • Two-thirds of the respondents reported plans to expand services within the next year.

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FQHCs FQHCs in the Finger Lakes region had the most difficulty recruiting internal medicine physicians, psychiatric NPs, and substance abuse counselors. FQHCs in the Finger Lakes region had the most difficulty retaining psychiatric NPs and family practice NPs (Table 64).

Table 64. Recruitment and Retention Difficulties for FQHCs in Selected Health Occupations in the Finger Lakes Region, 2016 Average Assessment of Difficulty Occupation Recruitment Retention Family/General Practice 4.4 3.0 Internal Medicine 5.0 3.5 Physicians Ob/Gyn 0.0 0.0 Pediatricians 4.5 2.0 Physician Assistants (PAs) 2.3 2.7 Overall – All Specialties 3.0 3.5 Pediatric 3.0 2.0 Nurse Practitioners Adult 0.0 0.0 Family 3.3 4.0 Psychiatric 5.0 5.0 Registered Nurses 3.8 2.8 Nurses Licensed Practical Nurses 2.7 3.3 Psychiatrists 0.0 0.0 Psychologists 0.0 0.0 Behavioral Health Substance Abuse Counselors 5.0 3.0 Social Workers 4.5 3.0 Dentists 4.3 3.3 Oral Health Dental Hygienists 3.0 2.3 Care Coordinators 4.0 3.0 Coordination/Patient Case Managers 4.0 3.0 Care HIV Counselors 4.0 3.0 Community Health Workers 4.0 3.0 Patient/Community Patient Health Educators 4.0 3.0 Education Nutritionists/Nutrition Educators 4.0 3.0 Patient Health Navigators 4.0 3.0 Outreach Workers 4.0 3.5 Enabling Services Transportation Workers 3.5 3.0 Interpreters 4.5 2.0 Administrative IT Systems Admin/Maintenance 2.5 2.0 Support Physical Therapists 0.0 0.0 Others Occupational Therapists 0.0 0.0 • All (100%) survey respondents indicated that they anticipated expanding services. • Sixty percent (60%) of FQHCs in this region indicated difficulty hiring bilingual staff; Spanish was the language most needed.

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Employment Projections by Health Occupation

According to the NYSDOL, the largest numbers of average annual job openings projected in the Finger Lakes region between 2012 and 2022 will be for RNs (350), home health aides (260), and nursing assistants (210) (Table 65).

Table 65. Employment Projections for Selected Health Occupations in the Finger Lakes Region, 2012-2022 Change Between Average Occupation 2012 2022 2012 and 2022 Annual a Number Percent Openings

Home Health Aides 5,910 7,380 1,470 24.9% 260 Personal Care Aides 5,740 7,150 1,410 24.6% 180 Registered Nurses 12,080 13,270 1,190 9.9% 350 Nursing Assistants 6,930 7,760 830 12.0% 210 Licensed Practical and Licensed Vocational 4,400 5,070 670 15.2% 180 Emergency Medical Technicians and 1,340 1,650 310 23.1% 70 Social Workers 3,030 3,280 250 8.3% 90 Physical Therapists 1,030 1,220 190 18.4% 50 Medical and Clinical Laboratory Technicians 910 1,100 190 20.9% 40 Physician Assistants 710 890 180 25.4% 30 Nurse Practitioners 920 1,090 170 18.5% 40 Medical and Health Services Managers 1,520 1,680 160 10.5% 60 Dental Hygienists 1,050 1,210 160 15.2% 50 Medical Assistants 710 860 150 21.1% 30 Pharmacy Technicians 1,110 1,240 130 11.7% 20 Diagnostic Medical Sonographers 280 380 100 35.7% 10 Dental Assistants 1,110 1,210 100 9.0% 30 Radiologic Technologists 720 810 90 12.5% 20 Occupational Therapists 620 700 80 12.9% 20 Medical Records and Health Info Techs 530 610 80 15.1% 20 Pharmacists 1,010 1,080 70 6.9% 30 Medical and Clinical Laboratory Technologists 790 860 70 8.9% 30 Speech-Language Pathologists 680 740 60 8.8% 20 Surgical Technologists 330 390 60 18.2% 10 Cardiovascular Technologists & Technicians 230 280 50 21.7% 10 Dietitians and Nutritionists 300 340 40 13.3% 0 Respiratory Therapists 350 380 30 8.6% 10 Clinical, Counseling, and School Psychologists 800 820 20 2.5% 20 Nurse Anesthetists 50 60 10 20.0% 0 a Annual openings reflect creation of new positions in the occupation and replacement for those retiring or otherwise leaving the profession. Source: New York State Department of Labor, Jobs in Demand/Projects, Long-Term Occupation Projections, 2012-2022

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E. Hudson Valley The Hudson Valley region includes the counties of Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster, and Westchester.

Population

The population of the Hudson Valley region had lower percentages of individuals below 100% and 200% of the FPL and was less diverse than the state overall. The Hudson Valley region also had a higher percentage of its population with a master’s degree or higher than the state as a whole (Table 66).

Table 66. Selected Population Characteristics in the Hudson Valley Region, 2010-2014 (5-Year Average) Region Statewide Population Characteristicsa Number Percent Percent Total population 2,310,598 N/A N/A Population under 100% FPL 244,955 10.6% 15.2% Population under 200% FPL 545,512 23.6% 31.7% Population aged birth to 17 years 549,981 23.8% 21.8% Population aged 65 and older 332,727 14.4% 14.1% Population female aged 15 to 44 431,607 18.7% 20.7% Women aged 15 to 19 who had a birth in past 12 mos. 1,072 0.0% 0.05% Women aged 20 to 34 who had a birth in past 12 mos. 18,252 0.8% 0.8% Women aged 35 to 50 who had a birth in past 12 mos. 9,098 0.4% 0.3% Black/African American, non-Hispanic 243,928 10.6% 14.4% Hispanic/Latino 415,309 18.0% 18.2% Asian/Pacific Islander, non-Hispanic 100,742 4.4% 7.7% American Indian/Native Alaskan, non-Hispanic 2,833 0.1% 0.2% Two or more/other 49,300 2.1% 2.2% Less than high school education 183,573 11.9% 14.6% High school or equivalent 646,639 41.9% 43.2% Associate degree 120,052 7.8% 8.5% Bachelor's degree 317,671 20.6% 19.1% Master's degree or higher 277,344 18.0% 14.6% a Education levels and rates are based on individuals aged 25 years and older. Source: US Census, American Community Survey, 2010-2014 (5-Year Average)

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Health Status

The Hudson Valley region had lower rates of total deaths, deaths due to heart disease, and deaths due to cancer than the state as a whole and upstate New York. The Hudson Valley region had lower rates of asthma hospitalizations (both adult and pediatric) than the state as a whole, but these rates were higher than their corresponding upstate New York rates. Total hospitalizations, preventable hospitalizations, and ED visits were also lower in Hudson Valley, compared with statewide and upstate rates (Table 67).

Table 67. Selected Health Indicators in the Hudson Valley Region, 2011-2013 (3-Year Average) Region Upstate Statewide Health Indicator Number Rate Number Rate Number Rate Total deaths, per 100,000 16,784 726.4 95,944 854.1 147,313 753.1 Deaths due to heart disease, per 100,000 4,802 207.8 26,818 238.7 43,448 222.1 Deaths due to all cancers, per 100,000 4,102 178.1 22,723 202.4 35,215 180.7 Deaths due to diabetes, per 100,000 353 15.3 2,198 19.6 3,975 20.3 Total births, per 1,000 females aged 15 to 44 25,893 60.1 120,237 56.8 238,078 59.0 Teen births, per 1,000 females aged 15 to 19 1,062 13.0 6,806 17.3 12,441 19.5 Low-birthweight births, as a percent of total births 1,868 7.2 9,150 7.6 19,006 8.0 Late/no prenatal care, as a percent of total births 1,011 4.0 4,845 4.1 13,148 5.6 Infant deaths, per 1,000 live births 125 4.8 667 5.5 1,179 5.0 Total hospitalizations, per 10,000 263,051 1,138.4 1,312,126 1,168.1 2,398,679 1,226.2 Preventable hospitalizations, per 10,000 29,893 129.4 158,173 140.8 293,493 150.0 Adult asthma hospitalizations, per 10,000 2,121 12.0 8,931 10.2 24,276 15.9 Pediatric asthma hospitalizations, per 10,000 839 15.3 3,513 14.2 11,340 26.6 Diabetes hospitalizations, per 10,000 3,260 14.1 17,503 15.6 37,847 19.3 CLRD hospitalizations, per 10,000 7,093 30.7 37,028 33.0 71,475 36.5 Heart disease hospitalizations, per 10,000 22,860 98.9 125,733 111.9 212,301 108.5 Total ED visits, per 10,000 792,017 3,427.6 4,215,240 3,752.5 7,993,838 4,086.4 Source: New York State Community Health Indicator Reports, 2011-2013 (3- Year Average)

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Primary Care Physicians

There were more than 3,000 primary care physicians practicing in the Hudson Valley region in 2015. Forty- five percent (45%) were in general internal medicine, 24% were in general pediatrics, and another 19% were in general or family practice. There were over 900 psychiatrists, including child and adolescent psychiatrists, practicing in the Hudson Valley region, or approximately 40.3 per 100,000. Westchester County had the highest rate of family, general, and internal medicine (general) physicians in the region with 106.0 per 100,000 population, whereas Sullivan County had the lowest rate with 48.0 per 100,000 (Table 68 and Figure 26).

Table 68. Primary Care Physicians and Psychiatrists in the Hudson Valley Region, by Specialty, 2015 Per 100,000 Specialty Physicians Populationa Family/General Practice 585 25.3 Internal Medicine (General) 1,405 60.8 Subtotal 1,990 86.1 Geriatrics 38 11.5 Obstetrics/Gynecology 354 82.0 Pediatrics (General) 771 140.2 Primary Care Total 3,154 N/A Psychiatrist 931 40.3 a All rates are per 100,000 total population except the Ob/Gyn rate, which is per 100,000 women aged 15 to 44, the pediatrician rate, which is per 100,000 children aged birth to 17 years, and the geriatrics rate, which is per 100,000 population aged 65 and older. Source: Center for Health Workforce Studies

Figure 26. Number of Selected Primary Care Physicians per 100,000 Population in the Hudson Valley Region, by County, 2015

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Employment

Total Health Sector Employment

Between 2010 and 2014, health sector employment in the Hudson Valley region increased by nearly 3%, adding slightly more than 2,700 jobs. All settings in the health sector experienced job growth between 2010 and 2014, except hospitals, which experienced a decrease of more than 1,600 jobs (-4%). Home health care had the largest percentage increase in jobs (16%), followed by ambulatory care (6%) and nursing home and personal care facilities (3%) (Table 69).

Table 69. Number of Health Care Jobs in the Hudson Valley Region, by Setting, 2010-2014 Change Between Setting 2010 2011 2012 2013 2014 2010 and 2014 Number Percent Hospitals 39,765 39,311 38,351 37,400 38,157 -1,608 -4.0% Ambulatory care 40,676 41,085 42,068 42,774 42,939 2,263 5.6% (excluding home health) Nursing home and personal 20,605 20,742 20,767 20,746 21,118 513 2.5% care facilities Home health care 9,499 10,517 10,343 10,782 11,037 1,538 16.2% Total 110,546 111,655 111,529 111,702 113,251 2,705 2.5% Source: New York State Department of Labor, ES-202

Employment and Wage by Occupation

Employment for selected health occupations is reported in Table 70. RNs in the Hudson Valley region accounted for the most jobs in the first quarter of 2015 (19,010), followed by personal care aides (15,180) and nursing assistants (11,370). Cardiovascular technologists and technicians and nuclear medicine technologists had the fewest jobs (320 and 130, respectively).

Wages in selected health occupations for the Hudson Valley region are reported in Table 71. These wages were based on 2012-2015 survey data, which were adjusted to include the first quarter of 2016. Certified registered nurse anesthetists earned the highest hourly wage in 2016 ($71.80), followed by medical and health service managers ($61.75) and pharmacists ($59.15). Home health aides ($12.65) earned the least amount for the selected health occupations in the Hudson Valley region.

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Table 70. Number of Jobs in Selected Health Occupations in the Hudson Valley Region, 2015 Occupation Employment Registered Nurses 19,010 Personal Care Aides 15,180 Nursing Assistants 11,370 Home Health Aides 10,760 Licensed Practical and Licensed Vocational Nurses 6,010 Social Workers 5,940 Dental Assistants 2,720 Medical Assistants 2,610 Medical and Health Services Managers 2,570 Pharmacy Technicians 2,270 Pharmacists 1,860 Speech-Language Pathologists 1,750 Dental Hygienists 1,710 Physical Therapists 1,690 Radiologic Technologists and Technicians 1,570 Medical Secretaries 1,320 Occupational Therapists 1,100 Medical Records and Health Information Technicians 1,030 Physician Assistants 1,010 Nurse Practitioners 830 Medical and Clinical Laboratory Technologists 760 Mental Health Counselors 750 Medical and Clinical Laboratory Technicians 720 Dietitians and Nutritionists 690 Respiratory Therapists 590 Physical Therapist Assistants 550 Occupational Therapy Assistants 460 Physical Therapist Aides 440 Surgical Technologists 410 Orderlies 400 Cardiovascular Technologists and Technicians 320 Nuclear Medicine Technologists 130 Source: New York State Department of Labor, Bureau of Labor Statistics, Occupational Wages

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Table 71. Average Hourly Wage in Selected Health Occupations in the Hudson Valley Region, 2016 Average Wage Occupation per Hour Nurse Anesthetists $71.80 Medical and Health Services Managers $61.75 Pharmacists $59.15 Speech-Language Pathologists $54.36 Nurse Practitioners $53.16 Physician Assistants $51.62 Nurse Midwives $49.96 Physical Therapists $43.82 Occupational Therapists $43.44 Nuclear Medicine Technologists $41.05 Registered Nurses $39.48 Dental Hygienists $39.00 Respiratory Therapists $35.61 Radiologic Technologists and Technicians $35.42 Medical and Clinical Laboratory Technologists $34.88 Dietitians and Nutritionists $32.14 Cardiovascular Technologists and Technicians $31.84 Social Workers $29.89 Occupational Therapy Assistants $29.32 Physical Therapist Assistants $26.85 Medical and Clinical Laboratory Technicians $25.85 Surgical Technologists $24.33 Licensed Practical and Licensed Vocational Nurses $24.15 Mental Health Counselors $21.58 Dietetic Technicians $21.53 Medical Records and Health Information Technicians $20.65 Dental Assistants $19.11 Medical Secretaries $18.22 Medical Assistants $16.84 Nursing Assistants $16.38 Occupational Therapy Aides $15.25 Pharmacy Technicians $15.22 Physical Therapist Aides $13.94 Orderlies $13.60 Personal Care Aides $13.59 Home Health Aides $12.65 Source: New York State Department of Labor, Labor Statistics, Occupational Wages

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Licensed Health Professionals

Between 2010 and 2014, the number of licensed RNs in the Hudson Valley region increased by more than 1,000, or by 3%. The number of physician assistants (32%) grew the fastest, followed by NPs (28%), and speech-language pathologists (19%). In contrast, the Hudson Valley experienced declines in the number of clinical laboratory technologists (-2%) and clinical laboratory technicians (-5%) (Table 72).

Table 72. Number of Licensed Individuals in Selected Health Occupations in the Hudson Valley Region, 2010-2014 Change Between Profession 2010 2011 2012 2013 2014 2010 and 2014 Number Percent Registered Nurses 31,875 31,788 32,299 33,026 32,884 1,009 3.2% Licensed Practical Nurses 7,621 7,763 7,763 7,951 8,001 380 5.0% Social Workers 7,160 7,383 7,448 7,643 7,748 588 8.2% Pharmacists 2,030 2,021 2,094 2,154 2,318 288 14.2% Physical Therapists 2,293 2,340 2,407 2,488 2,544 251 10.9% Nurse Practitioners 1,838 1,945 2,064 2,235 2,345 507 27.6% Speech-Language Pathologists 1,910 2,013 2,106 2,208 2,265 355 18.6% Clinical Laboratory Technologists 1,433 1,419 1,433 1,387 1,406 -27 -1.9% Physician Assistants 810 844 884 953 1,069 259 32.0% Occupational Therapists 1,353 1,408 1,421 1,462 1,507 154 11.4% Dental Hygienists 1,127 1,136 1,150 1,166 1,189 62 5.5% Respiratory Therapists 624 645 647 679 689 65 10.4% Physical Therapist Assistants 503 494 510 528 543 40 8.0% Dietitians/Nutritionists 717 705 733 758 751 34 4.7% Occupational Therapy Assistants 710 751 782 782 797 87 12.3% Clinical Laboratory Technicians 248 227 227 233 236 -12 -4.8% Source: New York State Education Department, Office of Professions

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Demand for Health Workers

Hospitals

Hospitals in the Hudson Valley region reported the most difficulty recruiting licensed mental health counselors, licensed clinical social workers, and clinical lab technologists. Licensed mental health counselors were also the most difficult to retain, followed by licensed clinical social workers, experienced RNs, and licensed master social workers (Table 73).

Table 73. Recruitment and Retention Difficulties for Hospitals in Selected Health Occupations in the Hudson Valley Region, 2016 Average Assessment of Percentage of Respondents Difficulty Indicating Reasons for Difficulties Occupation Shortage Salary Geographic Recruitment Retention of Levels Location Workers Experienced Registered Nurses 4.7 4.0 43% 71% 29% Newly Licensed Registered Nurses 2.3 3.8 29% 57% 14% Nurse Managers 3.1 1.5 14% 14% 14% CNA/Patient Care Techs 3.0 3.2 14% 86% 43% Nurse Practitioners 3.5 2.8 14% 14% 14% Physician Assistants 3.5 3.5 14% 57% 14% Pharmacists 2.3 2.8 14% 71% 29% Clinical Lab Technicians 1.8 1.5 14% 14% 14% Clinical Lab Technologists 5.0 1.7 86% 57% 57% Medical Hospital Coders 3.0 1.8 43% 0% 14% Occupational Therapists 3.0 3.0 29% 57% 14% Care Coordinators 1.5 1.0 14% 0% 14% Case Managers 2.2 1.2 29% 14% 14% Care Managers 1.5 1.0 14% 0% 14% Patient Navigators 2.0 1.6 29% 0% 14% Community Health Workers 1.5 1.0 14% 0% 14% Psychologists 1.8 1.5 0% 0% 0% Psychiatric NPs 4.0 1.0 43% 0% 0% Licensed Clinical Social Workers 5.0 4.5 29% 43% 0% Licensed Master Social Workers 4.2 4.0 14% 43% 0% Licensed Mental Health Counselors 5.0 5.0 0% 43% 0%

• Many hospitals projected growth in inpatient services, with increasing demand for care coordinators (71%), community health workers (57%), and patient navigators (57%). • Many hospitals projected growth in outpatient services, with increasing demand for LPNs (14%), newly licensed RNs (29%), and care coordinators (29%).

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Nursing Homes

Nursing homes in the Hudson Valley region reported the greatest difficulty recruiting nurse managers, dietitians/nutritionists, and experienced RNs. CNAs were the most difficult to retain for nursing homes in the region, followed by experienced RNs, and dietitians/nutritionists (Table 74).

Table 74. Recruitment and Retention Difficulties for Nursing Homes in Selected Health Occupations in the Hudson Valley Region, 2016 Average Assessment of Percentage of Respondents Indicating Difficulty Reasons for Difficulties Occupation Shortage Salary Recruitment Retention of Benefits Location Levels Workers Activities Director 2.4 2.0 8% 0% 0% 23% Certified Nurse Aides/Assts. (CNAs) 3.1 3.6 47% 40% 7% 20% Dietary Aides 2.9 3.0 13% 20% 0% 20% Dietitians/Nutritionists 3.8 3.3 31% 15% 0% 15% Housekeeping Staff 2.7 2.5 13% 13% 0% 20% Licensed Practical Nurses 3.0 3.5 43% 36% 14% 21% Medical Billers 2.6 2.5 14% 0% 0% 0% Occupational Therapists 3.2 2.5 36% 14% 7% 7% Occupational Therapy Assistants 3.1 2.5 21% 14% 0% 14% Physical Therapists 3.2 2.5 29% 14% 7% 14% Physical Therapist Assistants 3.0 2.4 31% 8% 0% 8% Registered Nurses (RNs) Newly Licensed RNs 3.1 2.6 17% 25% 17% 17% Experienced RNs 3.7 3.5 40% 40% 13% 27% MDS Coordinators 2.9 2.4 25% 17% 8% 8% Nurse Manager 3.8 3.1 36% 36% 14% 14% Director of Nursing 3.1 2.3 25% 17% 17% 17% Recreational Therapists 3.3 2.8 29% 29% 14% 14% Respiratory Therapists 3.3 2.2 14% 0% 0% 14% Social Workers (SWs) Licensed Clinical SWs 2.9 2.4 17% 8% 0% 8% Licensed Master SWs 3.1 2.7 21% 14% 7% 7% Speech-Language Pathologists 3.0 2.5 11% 0% 0% 11%

• Fifty-three percent (53%) of nursing homes reported difficulty hiring part-time workers. • Sixty-seven percent (67%) of nursing homes indicated difficulty hiring workers for off shifts (evenings, nights, and weekends).

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Home Health Care Agencies

Home health care agencies in the Hudson Valley region reported the most difficulty recruiting speech- language pathologists, followed by experienced RNs and home health aides. Home health aides and personal care aides were the most difficult to retain, followed by homemakers and speech-language pathologists (Table 75).

Table 75. Recruitment and Retention Difficulties for Home Health Care Agencies in Selected Health Occupations in the Hudson Valley Region, 2016 Average Assessment of Percentage of Respondents Indicating Reasons Difficulty for Difficulties Non- Occupation Lack of Competitive Recruitment Retention Shortage Specialized Location Salaries/ Training Benefits Home Health Aides 4.2 4.5 83% 67% 17% 20% Homemakers 3.7 4.3 0% 33% 0% 33% Personal Care Aides 3.0 4.5 50% 0% 0% 50% Dietitians/Nutritionists 2.7 2.3 0% 0% 0% 67% Licensed Practical Nurses 3.3 3.0 33% 50% 33% 17% Occupational Therapists 4.0 3.0 0% 25% 25% 25% Physical Therapists 4.0 3.5 60% 40% 0% 20% Registered Nurses Newly Licensed RNs 2.2 2.5 20% 0% 25% 25% Experienced RNs 4.4 3.5 43% 43% 29% 29% Respiratory Therapists 4.0 2.0 0% 0% 0% 100% Social Workers (SWs) Licensed Clinical SWs 3.0 3.0 25% 25% 25% 25% Licensed Master SWs 3.0 3.3 25% 50% 25% 25% Speech-Language Pathologists 4.5 4.3 100% 50% 0% 50%

• Twenty-nine (29%) of home health care agencies reported difficulty hiring part-time workers. • Forty-three (43%) of home health care agencies reported difficulty hiring bilingual workers. • Twenty-nine percent (29%) of home health care agencies indicated difficulty hiring workers for off shifts (evenings, nights, and weekends). • Over 60% of home health care agencies in the Hudson Valley planned to expand services within the next year.

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FQHCs Hudson Valley and Capital District regions were combined due to low response rates to the survey. FQHCs in these regions had the most difficulty recruiting family/general practice physicians, Ob/Gyns, and LPNs. FQHCs in these regions had the most difficulty retaining IT staff and RNs (Table 76).

Table 76. Recruitment and Retention Difficulties for FQHCs in Selected Health Occupations in the Hudson Valley and Capital District Regions, 2016 Average Assessment of Difficulty Occupation Recruitment Retention Family/General Practice 3.8 2.2 Internal Medicine 3.6 2.2 Physicians Ob/Gyn 3.8 2.6 Pediatricians 2.5 2.2 Physician Assistants (PAs) 2.2 2.6 Overall – All Specialties 2.6 2.6 Pediatric 2.5 2.3 Nurse Practitioners Adult 2.3 2.3 Family 2.6 2.6 Psychiatric 2.8 2.7 Registered Nurses 3.3 2.8 Nurses Licensed Practical Nurses 3.8 2.7 Psychiatrists 3.3 2.3 Psychologists 2.7 3.0 Behavioral Health Substance Abuse Counselors 2.5 2.7 Social Workers 2.8 2.3 Dentists 2.8 2.3 Oral Health Dental Hygienists 2.5 2.3 Care Coordinators 3.3 2.7 Coordination/Patient Case Managers 2.0 2.3 Care HIV Counselors 1.0 1.0 Community Health Workers 1.0 1.0 Patient/Community Patient Health Educators 1.0 1.0 Education Nutritionists/Nutrition Educators 2.3 2.3 Patient Health Navigators 1.0 1.0 Outreach Workers 1.0 1.0 Enabling Services Transportation Workers 1.0 1.0 Interpreters 1.0 1.0 Administrative Support IT Systems Admin/Maintenance 3.5 2.8 Physical Therapists 3.0 1.0 Others Occupational Therapists 2.0 1.0

• Sixty percent (60%) of FQHCs in these regions indicated difficulty hiring bilingual staff; Spanish was the language most needed. • Eighty percent (80%) of FQHCs in these regions reported expansion plans for one or more service.

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Employment Projections by Health Occupation

According to the NYSDOL, the largest numbers of average annual job openings projected in the Hudson Valley region between 2012 and 2022 will be for RNs (640), home health aides (620), and personal care aides (590) (Table 77).

Table 77. Employment Projections for Selected Health Occupations in the Hudson Valley Region, 2012 and 2022 Change Between Average Occupation 2012 2022 2012 and 2022 Annual Number Percent Openingsa Personal Care Aides 13,810 18,670 4,860 35.2% 590 Home Health Aides 9,510 13,890 4,380 46.1% 620 Registered Nurses 17,860 20,790 2,930 16.4% 640 Nursing Assistants 11,510 13,730 2,220 19.3% 440 Licensed Practical and Licensed Vocational 6,310 8,140 1,830 29.0% 330 Social Workers 5,730 6,560 830 14.5% 200 Medical Assistants 2,470 3,210 740 30.0% 120 Physical Therapists 1,860 2,440 580 31.2% 110 Medical and Health Services Managers 2,740 3,170 430 15.7% 110 Emergency Medical Technicians and 1,520 1,930 410 27.0% 80 Physician Assistants 880 1,240 360 40.9% 60 Dental Assistants 2,170 2,510 340 15.7% 90 Dental Hygienists 1,360 1,670 310 22.8% 70 Nurse Practitioners 920 1,210 290 31.5% 50 Speech-Language Pathologists 1,490 1,720 230 15.4% 40 Diagnostic Medical Sonographers 560 790 230 41.1% 30 Pharmacy Technicians 1,320 1,550 230 17.4% 30 Medical Records and Health Info Techs 990 1,220 230 23.2% 50 Clinical, Counseling, and School Psychologists 1,920 2,120 200 10.4% 70 Occupational Therapists 1,070 1,270 200 18.7% 30 Radiologic Technologists 1,190 1,380 190 16.0% 40 Pharmacists 1,690 1,870 180 10.7% 60 Medical and Clinical Laboratory Technicians 740 910 170 23.0% 40 Dietitians and Nutritionists 710 860 150 21.1% 30 Respiratory Therapists 740 890 150 20.3% 30 Cardiovascular Technologists & Technicians 430 560 130 30.2% 20 Surgical Technologists 530 640 110 20.8% 20 Medical and Clinical Laboratory Technologists 720 790 70 9.7% 30 Psychiatric Aides 1,430 1,480 50 3.5% 30 Orderlies 220 250 30 13.6% 0 a Annual openings reflect creation of new positions in the occupation and replacement for those retiring or otherwise leaving the profession. Source: New York State Department of Labor, Jobs in Demand/Projects, Long-Term Occupation Projections, 2012-2022

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F. Long Island The Long Island region includes the counties of Nassau and Suffolk.

Population

The Long Island region had a significantly lower percentage of individuals below 100% and 200% of the FPL compared to the statewide average. The region had similar rates of education compared to the statewide percentage (Table 78).

Table 78. Selected Population Characteristics in the Long Island Region, 2010-2014 (5-Year Average) Population Characteristics Region Statewide Number Percent Percent Total population 2,850,974 N/A N/A Population under 100% FPL 184,047 6.5% 15.2% Population under 200% FPL 484,403 17.0% 31.7% Population aged birth to 17 years 650,717 22.8% 21.8% Population aged 65 and older 429,370 15.1% 14.1% Population female aged 15 to 44 528,795 18.5% 20.7% Women aged 15 to 19 who had a birth in past 12 mos. 643 0.0% 0.05% Women aged 20 to 34 who had a birth in past 12 mos. 19,498 0.7% 0.8% Women aged 35 to 50 who had a birth in past 12 mos. 10,796 0.4% 0.3% Black/African American, non-Hispanic 252,356 8.9% 14.4% Hispanic/Latino 469,173 16.5% 18.2% Asian/Pacific Islander, non-Hispanic 164,316 5.8% 7.7% American Indian/Native Alaskan, non-Hispanic 3,594 0.1% 0.2% Two or more/other 46,951 1.6% 2.2% Less than high school education 193,888 10.0% 14.6% High school or equivalent 854,265 43.9% 43.2% Associate degree 164,980 8.5% 8.5% Bachelor's degree 402,455 20.7% 19.1% Master's degree or higher 329,914 17.0% 14.6% a Education levels and rates are based on individuals aged 25 years and older. Source: US Census, American Community Survey, 2010-2014 (5-Year Average)

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Health Status

The Long Island region had higher rates of total deaths and deaths due to all cancers and heart disease than the state as a whole, but it had lower rates of deaths due to diabetes. The rate of total hospitalizations was higher in the Long Island region compared with the statewide and upstate rates. In contrast, the rate of ED visits on Long Island was lower than both the statewide rate and upstate rates. All of the natality indicators listed, including total births, teen births, low-birthweight births, late/no prenatal care, and infant deaths, were better in the Long Island region than statewide. The Long Island region, however, had a higher rate of heart disease hospitalizations than the upstate region and the state as a whole (Table 79).

Table 79. Selected Health Indicators in the Long Island Region, 2011-2013 (3-Year Average) Region Upstate Statewide Health Indicator Number Rate Number Rate Number Rate Total deaths, per 100,000 22,219 780.2 95,944 854.1 147,313 753.1 Deaths due to heart disease, per 100,000 7,244 254.4 26,818 238.7 43,448 222.1 Deaths due to all cancers, per 100,000 5,323 187.2 22,723 202.4 35,215 180.7 Deaths due to diabetes, per 100,000 398 14.0 2,198 19.6 3,975 20.3 Total births, per 1,000 females aged 15 to 44 29,726 56.4 120,237 56.8 238,078 59.0 Teen births, per 1,000 females aged 15 to 19 1,039 10.7 6,806 17.3 12,441 19.5 Low-birthweight births, as a percent of total births 2,316 7.8 9,150 7.6 19,006 8.0 Late/no prenatal care, as a percent of total births 1,051 3.6 4,845 4.1 13,148 5.6 Infant deaths, per 1,000 live births 121 4.1 667 5.5 1,179 5.0 Total hospitalizations, per 10,000 360,849 1,267.1 1,312,126 1,168.1 2,398,679 1,226.2 Preventable hospitalizations, per 10,000 43,011 151.0 158,173 140.8 293,493 150.0 Adult asthma hospitalizations, per 10,000 2,775 12.6 8,931 10.2 24,276 15.9 Pediatric asthma hospitalizations, per 10,000 1,275 19.6 3,513 14.2 11,340 26.6 Diabetes hospitalizations, per 10,000 4,643 16.3 17,503 15.6 37,847 19.3 CLRD hospitalizations, per 10,000 9,662 33.9 37,028 33.0 71,475 36.5 Heart disease hospitalizations, per 10,000 37,316 131.0 125,733 111.9 212,301 108.5 Total ED visits, per 10,000 969,178 3,403.2 4,215,240 3,752.5 7,993,838 4,086.4 Source: New York State Community Health Indicator Reports, 2011-2013 (3- Year Average)

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Primary Care Physicians

There were more than 3,800 primary care physicians practicing in the Long Island region. Forty-two percent (42%) were in general internal medicine, 23% were in general pediatrics, and another 22% were in general or family practice. There were over 700 psychiatrists, including child and adolescent psychiatrists, practicing in the Long Island region, or approximately 25.4 per 100,000. Nassau County had 101.5 family/general, and internal medicine (general) practitioners per 100,000 population, whereas Suffolk County only had 73.2 of those physicians per 100,000 total population (Table 80 and Figure 27).

Table 80. Primary Care Physicians and Psychiatrists in the Long Island Region, by Specialty

Per 100,000 Specialty Physicians Populationa Family/General Practice 838 29.4 Internal Medicine (General) 1,631 57.2 Subtotal 2,469 86.6 Geriatrics 51 11.8 Obstetrics/Gynecology 458 86.6 Pediatrics (General) 878 134.9 Primary Care Total 3,855 N/A Psychiatrist 723 25.4 a All rates are per 100,000 total population except the Ob/Gyn rate, which is per 100,000 women aged 15 to 44, the pediatrician rate, which is per 100,000 children aged birth to 17 years, and the geriatrics rate, which is per 100,000 population aged 65 and older. 2015Source: Center for Health Workforce Studies

Figure 27. Number of Selected Primary Care Physicians per 100,000 Population in the Long Island Region, by County, 2015

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Employment

Total Health Sector Employment

Health sector employment in the Long Island region grew by nearly 3% between 2010 and 2014, adding more than 4,000 jobs. Employment in home health care grew the fastest, increasing by 27% between 2010 and 2014. There was also growth in ambulatory care (4%), while the number of jobs in nursing home and personal care facilities and in hospitals decreased by 5% and 1%, respectively, during the same time period.

Table 81. Number of Health Care Jobs in the Long Island Region, by Setting, 2010-2014 Change Between Setting 2010 2011 2012 2013 2014 2010 and 2014 Number Percent Hospitals 62,646 64,558 62,754 62,687 61,907 -739 -1.2% Ambulatory care 61,385 62,110 62,528 63,485 63,968 2,583 4.2% (excluding home health) Nursing home and 24,244 24,399 23,918 22,722 22,934 -1310 -5.4% personal care facilities Home health care 13,120 13,561 14,630 15,580 16,649 3,529 26.9% Total 161,395 164,628 163,830 164,474 165,458 4,063 2.5% Source: New York State Department of Labor, ES-202

Employment and Wage by Occupation

Employment for selected health occupations in the Long Island region is reported in Table 82. RNs (25,340) on Long Island accounted for the most jobs in the first quarter of 2015, followed by personal care aides (23,270), nursing assistants (14,010), and home health aides (9,360). Occupational therapy assistants and aides, nuclear medicine technologists, and dietetic technicians had the fewest jobs (390, 210, and 110, respectively).

Wages in selected health occupations for Long Island are reported in Table 83. These wages were based on 2012-2015 survey data, which were adjusted to include the first quarter of 2016. Certified registered nurse anesthetists earned the highest hourly wage in 2016 ($83.32), followed by medical and health service managers ($71.63), pharmacists ($60.00), and NPs ($55.73). Personal care aides ($12.75) and home health aides ($11.61) were the lowest wage earners among the selected health occupations in the Long Island region.

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Table 82. Number of Jobs in Selected Health Occupations in the Long Island Region, 2015 Occupation Employment Registered Nurses 25,340 Personal Care Aides 23,270 Nursing Assistants 14,010 Home Health Aides 9,360 Licensed Practical and Licensed Vocational Nurses 6,620 Social Workers 5,680 Medical Assistants 4,580 Medical and Health Services Managers 4,160 Dental Assistants 3,870 Physical Therapists 3,460 Pharmacists 2,800 Pharmacy Technicians 2,770 Physician Assistants 2,370 Radiologic Technologists and Technicians 2,320 Dental Hygienists 2,090 Speech-Language Pathologists 2,040 Medical Secretaries 1,840 Nurse Practitioners 1,780 Medical and Clinical Laboratory Technologists 1,600 Occupational Therapists 1,300 Medical Records and Health Information Technicians 1,300 Physical Therapist Assistants 1,040 Physical Therapist Aides 930 Medical and Clinical Laboratory Technicians 910 Orderlies 840 Respiratory Therapists 790 Dietitians and Nutritionists 710 Mental Health Counselors 700 Cardiovascular Technologists and Technicians 670 Surgical Technologists 550 Occupational Therapy Assistants 390 Nuclear Medicine Technologists 210 Dietetic Technicians 110 Source: New York State Department of Labor, Bureau of Labor Statistics, Occupational Wages

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Table 83. Average Hourly Wage in Selected Health Occupations in the Long Island Region, 2016 Average Wage Occupation per Hour Nurse Anesthetists $83.32 Medical and Health Services Managers $71.63 Pharmacists $60.00 Nurse Practitioners $55.73 Nurse Midwives $54.26 Physician Assistants $49.76 Speech-Language Pathologists $48.55 Physical Therapists $42.92 Occupational Therapists $42.86 Registered Nurses $40.88 Nuclear Medicine Technologists $40.56 Dental Hygienists $38.64 Respiratory Therapists $36.27 Medical and Clinical Laboratory Technologists $35.34 Radiologic Technologists and Technicians $34.37 Social Workers $31.06 Occupational Therapy Assistants $30.82 Dietitians and Nutritionists $30.36 Cardiovascular Technologists and Technicians $29.88 Physical Therapist Assistants $29.16 Surgical Technologists $27.22 Licensed Practical and Licensed Vocational Nurses $25.67 Medical and Clinical Laboratory Technicians $24.30 Medical Records and Health Information Technicians $23.66 Dietetic Technicians $22.70 Medical Secretaries $20.29 Mental Health Counselors $20.12 Dental Assistants $19.52 Occupational Therapy Aides $19.11 Nursing Assistants $18.08 Medical Assistants $17.78 Orderlies $16.92 Pharmacy Technicians $15.72 Physical Therapist Aides $14.49 Personal Care Aides $12.75 Home Health Aides $11.61 Source: New York State Department of Labor, Labor Statistics, Occupational Wages

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Licensed Health Professionals

Between 2010 and 2014, the number of licensed RNs on Long Island increased by nearly 2,300, or 6%. During the same period, there were increases in the number of most of the other licensed health professionals, including social workers (967), PAs (797), NPs (673), pharmacists (625), and speech-language pathologists (621). The occupations with the greatest percentage growth in numbers included PAs (40%), NPs (24%), and speech-language pathologists (19%). In contrast, the number of licensed clinical laboratory technicians declined by 38, or by 11%, between 2010 and 2014 (Table 84).

Table 84. Number of Licensed Individuals in Selected Health Occupations in the Long Island Region, 2010-2014 Change Between Profession 2010 2011 2012 2013 2014 2010 and 2014 Number Percent Registered Nurses 40,185 40,574 41,377 42,592 42,502 2,317 5.8% Licensed Practical Nurses 8,718 8,884 8,922 8,979 9,064 346 4.0% Social Workers 8,464 8,717 8,965 9,246 9,431 967 11.4% Pharmacists 3,741 3,805 3,938 4,060 4,366 625 16.7% Physical Therapists 3,342 3,367 3,490 3,608 3,769 427 12.8% Nurse Practitioners 2,765 2,890 3,051 3,287 3,438 673 24.3% Speech-Language Pathologists 3,222 3,389 3,575 3,759 3,843 621 19.3% Clinical Laboratory Technologists 2,410 2,381 2,424 2,414 2,443 33 1.4% Physician Assistants 1,987 2,120 2,248 2,466 2,784 797 40.1% Occupational Therapists 1,860 1,916 2,000 2,102 2,176 316 17.0% Dental Hygienists 1,699 1,720 1,730 1,784 1,821 122 7.2% Respiratory Therapists 936 983 997 1,023 1,051 115 12.3% Physical Therapist Assistants 973 958 990 1,008 1,043 70 7.2% Dietitians/Nutritionists 966 975 1,023 1,040 1,051 85 8.8% Occupational Therapy Assistants 396 413 419 427 417 21 5.3% Clinical Laboratory Technicians 352 323 327 311 314 -38 -10.8% Source: New York State Education Department, Office of Professions

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Demand for Health Workers

Hospitals

Hospitals in the Long Island region reported the most difficulty recruiting medical coders, followed by psychiatric NPs, nurse practitioners, clinical lab technologists, nurse managers, and PAs. Community health workers were the most difficult to retain, followed newly licensed RNs, clinical lab technicians, care managers, and medical coders (Table 85).

Table 85. Recruitment and Retention Difficulties for Hospitals in Selected Health Occupations in the Long Island Region, 2016 Average Assessment of Percentage of Respondents Difficulty Indicating Reasons for Difficulties Occupation Shortage Salary Geographic Recruitment Retention of Levels Location Workers Experienced Registered Nurses 3.1 2.3 71% 71% 93% Newly Licensed Registered Nurses 1.4 3.7 0% 0% 7% Nurse Managers 3.8 2.9 75% 4% 29% CNA/Patient Care Techs 1.5 2.6 0% 4% 4% Nurse Practitioners 3.9 2.2 89% 64% 68% Physician Assistants 3.8 2.3 86% 64% 68% Pharmacists 3.2 2.2 86% 0% 68% Clinical Lab Technicians 3.7 3.7 68% 68% 71% Clinical Lab Technologists 3.9 2.4 96% 68% 96% Medical Hospital Coders 4.6 3.1 89% 0% 4% Occupational Therapists 3.8 1.6 0% 0% 4% Care Coordinators 3.6 2.6 68% 0% 68% Case Managers 3.6 2.9 68% 0% 68% Care Managers 3.6 3.1 68% 0% 68% Patient Navigators 2.4 2.7 68% 0% 7% Community Health Workers 3.0 4.5 64% 0% 4% Psychologists 3.0 2.9 68% 64% 68% Psychiatric NPs 4.1 3.0 96% 68% 71% Licensed Clinical Social Workers 3.5 2.2 64% 0% 64% Licensed Master Social Workers 2.9 2.9 64% 0% 64% Licensed Mental Health Counselors 2.9 1.5 64% 0% 64%

• Many hospitals projected growth in inpatient services, with increasing demand for NPs (71%), care managers (68%), and CNAs (68%). • Many hospitals projected growth in outpatient services, with increasing demand for radiologic technologists (89%), community health workers (89%), and care coordinators (89%).

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Nursing Homes

Nursing homes in the Long Island region reported the most difficulty recruiting experienced RNs and MDS coordinators, followed by nurse managers, directors of nursing, occupational therapists, and newly licensed RNs. CNAs and dietary aides were the most difficult to retain, followed by experienced RNs and nurse managers (Table 86).

Table 86. Recruitment and Retention Difficulties for Nursing Homes in Selected Health Occupations in the Long Island Region, 2016 Average Assessment of Percentage of Respondents Indicating Difficulty Reasons for Difficulties Occupation Shortage Salary Recruitment Retention of Benefits Location Levels Workers Activities Director 2.3 1.9 20% 10% 10% 10% Certified Nurse Aides/Assts. (CNAs) 2.7 3.6 17% 25% 25% 33% Dietary Aides 2.7 3.6 17% 25% 25% 33% Dietitians/Nutritionists 2.2 2.1 9% 9% 9% 9% Housekeeping Staff 1.9 2.3 18% 9% 9% 9% Licensed Practical Nurses 2.8 3.2 25% 42% 17% 25% Medical Billers 2.8 2.6 33% 17% 17% 17% Occupational Therapists 3.1 2.3 33% 22% 11% 22% Occupational Therapy Assistants 2.9 2.4 33% 22% 11% 22% Physical Therapists 2.8 2.5 22% 22% 11% 22% Physical Therapist Assistants 2.7 2.4 11% 11% 11% 22% Registered Nurses (RNs) Newly Licensed RNs 3.1 2.5 27% 36% 18% 18% Experienced RNs 3.7 3.3 50% 33% 25% 25% MDS Coordinators 3.7 2.6 50% 20% 10% 10% Nurse Manager 3.6 3.3 60% 30% 10% 10% Director of Nursing 3.3 2.8 27% 27% 9% 18% Recreational Therapists 2.5 2.5 8% 17% 8% 17% Respiratory Therapists 2.5 2.0 60% 20% 20% 20% Social Workers (SWs) Licensed Clinical SWs 2.6 2.3 13% 25% 13% 13% Licensed Master SWs 2.6 2.5 17% 25% 8% 17% Speech-Language Pathologists 2.5 2.5 20% 20% 20% 20% Other information reported by nursing homes in the Long Island region included: • Forty-two percent (42%) of nursing homes reported difficulty hiring part-time workers. • Eight percent (8%) of nursing homes reported difficulty hiring bilingual workers. • Fifty percent (50%) of nursing homes indicated difficulty hiring workers for off shifts (evenings, nights, and weekends). • Twenty-five percent (25%) of nursing homes indicated they were planning to expand service in the next year. No nursing homes planned to reduce services.

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Home Health Care Agencies

Home health care agencies in the Long Island region reported the most difficulty recruiting respiratory therapists, followed by experienced RNs, and speech-language pathologists. Personal care aides were the most difficult to retain, followed by home health aides, homemakers, experienced RNs, and speech-language pathologists (Table 87).

Table 87. Recruitment and Retention Difficulties for Home Health Care Agencies in Selected Health Occupations in the Long Island Region, 2016 Average Assessment of Percentage of Respondents Indicating Reasons for Difficulty Difficulties Occupation Non- Lack of Recruitment Retention Shortage Competitive Specialized Location Salaries/Benefits Training Home Health Aides 2.0 3.0 33% 0% 0% 67% Homemakers 2.0 3.0 0% 0% 0% 100% Personal Care Aides 2.0 4.0 0% 0% 0% 100% Dietitians/Nutritionists 2.5 2.0 0% 0% 0% 50% Licensed Practical Nurses 2.2 2.0 20% 0% 20% 20% Occupational Therapists 3.3 2.0 0% 0% 0% 25% Physical Therapists 3.3 2.5 50% 25% 0% 25% Registered Nurses Newly Licensed RNs 2.0 2.5 33% 0% 0% 50% Experienced RNs 3.8 3.0 60% 20% 20% 40% Respiratory Therapists 4.0 2.5 0% 0% 0% 100% Social Workers (SWs) Licensed Clinical SWs 2.3 2.0 0% 0% 0% 33% Licensed Master SWs 2.0 2.0 0% 0% 0% 25% Speech-Language Pathologists 3.5 3.0 75% 25% 0% 75%

• Forty percent (40%) of home health care agencies reported difficulty hiring part-time workers. • One-fifth (20%) of home health care agencies reported difficulty hiring bilingual workers. • Forty percent (40%) of home health care agencies indicated difficulty hiring workers for off shifts (evenings, nights, and weekends). • The majority of respondents indicated that there would not be any expansion or reduction of services within the next year.

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FQHCs

New York City and Long Island regions were combined due to low survey response rates. FQHCs in these regions had the most difficulty recruiting and retaining physical therapists and occupational therapists (Table 88).

Table 88. Recruitment and Retention Difficulties for FQHCs in Selected Health Occupations in the New York City and Long Island Region, 2016 Average Assessment of Difficulty Occupation Recruitment Retention Family/General Practice 4.2 2.7 Internal Medicine 4.1 2.8 Physicians Ob/Gyn 4.0 2.8 Pediatricians 3.3 3.0 Physician Assistants (PAs) 2.7 3.0 Overall – All Specialties 3.3 2.5 Pediatric 3.5 2.7 Nurse Practitioners Adult 3.1 2.5 Family 3.7 3.0 Psychiatric 4.4 3.0 Registered Nurses 3.9 3.3 Nurses Licensed Practical Nurses 3.5 2.8 Psychiatrists 4.6 3.3 Psychologists 4.2 4.0 Behavioral Health Substance Abuse Counselors 1.0 0.0 Social Workers 3.7 3.0 Dentists 3.4 2.3 Oral Health Dental Hygienists 2.8 2.6 Care Coordinators 3.3 3.2 Coordination/Patient Case Managers 3.3 3.2 Care HIV Counselors 2.2 2.0 Community Health Workers 2.4 2.7 Patient/Community Patient Health Educators 2.8 2.0 Education Nutritionists/Nutrition Educators 3.3 2.7 Patient Health Navigators 2.6 2.0 Outreach Workers 2.4 2.0 Enabling Services Transportation Workers 2.0 1.5 Interpreters 1.0 1.0 Administrative Support IT Systems Admin/Maintenance 3.2 3.0 Physical Therapists 5.0 5.0 Others Occupational Therapists 5.0 5.0

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Employment Projections by Health Occupation

According to the NYSDOL, the largest numbers of average annual job openings projected in the Long Island region between 2012 and 2022 will be for home health aides (860), RNs (830), and personal care aides (820) (Table 89).

Table 89. Employment Projections for Selected Health Occupations in the Long Island Region, 2012 and 2022 Change Between Average Occupation 2012 2022 2012 and 2022 Annual Number Percent Openingsa Personal Care Aides 15,620 22,720 7,100 45.5% 820 Home Health Aides 12,890 19,000 6,110 47.4% 860 Registered Nurses 24,290 27,850 3,560 14.7% 830 Nursing Assistants 16,080 18,460 2,380 14.8% 550 Licensed Practical and Licensed Vocational 6,800 8,490 1,690 24.9% 340 Medical Assistants 5,470 7,090 1,620 29.6% 260 Social Workers 5,870 6,740 870 14.8% 210 Physical Therapists 2,840 3,660 820 28.9% 150 Physician Assistants 2,230 2,980 750 33.6% 120 Dental Assistants 3,760 4,430 670 17.8% 150 Emergency Medical Technicians and 2,590 3,130 540 20.8% 120 Medical and Health Services Managers 3,900 4,430 530 13.6% 150 Dental Hygienists 1,980 2,490 510 25.8% 100 Nurse Practitioners 1,550 1,990 440 28.4% 70 Radiologic Technologists 2,420 2,860 440 18.2% 70 Pharmacy Technicians 2,390 2,810 420 17.6% 60 Diagnostic Medical Sonographers 830 1,170 340 41.0% 40 Medical and Clinical Laboratory Technicians 1,190 1,510 320 26.9% 60 Pharmacists 2,640 2,950 310 11.7% 90 Speech-Language Pathologists 2,040 2,330 290 14.2% 60 Medical Records and Health Info Techs 1,310 1,570 260 19.8% 70 Occupational Therapists 1,200 1,450 250 20.8% 50 Medical and Clinical Laboratory 1,770 1,950 180 10.2% 70 Respiratory Therapists 1,060 1,230 170 16.0% 40 Cardiovascular Technologists & Technicians 640 800 160 25.0% 30 Surgical Technologists 680 820 140 20.6% 20 Dietitians and Nutritionists 680 800 120 17.6% 20 Nurse Anesthetists 430 540 110 25.6% 20 Psychiatric Aides 1,200 1,310 110 9.2% 30 Clinical, Counseling, and School 1,870 1,970 100 5.3% 60 Orderlies 350 400 50 14.3% 20 a Annual openings reflect creation of new positions in the occupation and replacement for those retiring or otherwise leaving the profession. Source: New York State Department of Labor, Jobs in Demand/Projects, Long-Term Occupation Projections, 2012-2022

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G. Mohawk Valley The Mohawk Valley region includes the counties of Fulton, Herkimer, Montgomery, Oneida, Otsego, and Schoharie.

Population

The Mohawk Valley region population was much less racially and ethnically diverse and older than New York as a whole. The Mohawk Valley region also had a higher percentage of people with a high school diploma or equivalent, but a smaller percentage of people with a bachelor’s degree or higher than the state as a whole (Table 90).

Table 90. Selected Population Characteristics in the Mohawk Valley Region, 2010-2014 (5-Year Average) Region Statewide Population Characteristicsa Number Percent Percent Total population 497,025 N/A N/A Population under 100% FPL 77,808 15.7% 15.2% Population under 200% FPL 171,324 34.5% 31.7% Population aged birth to 17 years 104,383 21.0% 21.8% Population aged 65 and older 84,764 17.1% 14.1% Population female aged 15 to 44 90,558 18.2% 20.7% Women aged 15 to 19 who had a birth in past 12 mos. 320 0.1% 0.05% Women aged 20 to 34 who had a birth in past 12 mos. 4,259 0.9% 0.8% Women aged 35 to 50 who had a birth in past 12 mos. 1,050 0.2% 0.3% Black/African American, non-Hispanic 16,819 3.4% 14.4% Hispanic/Latino 23,252 4.7% 18.2% Asian/Pacific Islander, non-Hispanic 9,835 2.0% 7.7% American Indian/Native Alaskan, non-Hispanic 798 0.2% 0.2% Two or more/other 8,713 1.8% 2.2% Less than high school education 43,438 12.8% 14.6% High school or equivalent 182,364 53.6% 43.2% Associate degree 41,005 12.1% 8.5% Bachelor's degree 42,777 12.6% 19.1% Master's degree or higher 30,708 9.0% 14.6% a Education levels and rates are based on individuals aged 25 years and older. Source: US Census, American Community Survey, 2010-2014 (5-Year Average)

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Health Status

The Mohawk Valley region had much higher rates of total deaths, including deaths due to heart disease, deaths due to all cancer, and deaths due to diabetes, than the state as a whole and upstate New York. Additionally, the rates of total hospitalizations as well as hospitalizations due to chronic lower respiratory disease, and heart disease were all higher than the state or upstate New York rates. The rates of preventable hospitalizations and ED visits were also much higher in the Mohawk Valley region compared with rates statewide and upstate New York. Although it had a lower total birth rate than statewide, the Mohawk Valley had a higher teen birth rate than the state as a whole (Table 91).

Table 91. Selected Health Indicators in the Mohawk Valley Region, 2011-2013 (3-Year Average) Region Statewide Upstate Health Indicator Number Rate Number Rate Number Rate Total deaths, per 100,000 5,166 1,039.7 147,313 753.1 95,944 854.1 Deaths due to heart disease, per 100,000 1,475 296.9 43,448 222.1 26,818 238.7 Deaths due to all cancers, per 100,000 1,129 226.5 35,215 180.7 22,723 202.4 Deaths due to diabetes, per 100,000 138 27.7 3,975 20.3 2,198 19.6 Total births, per 1,000 females aged 15 to 44 5,225 57.7 238,078 59.0 120,237 56.8 Teen births, per 1,000 females aged 15 to 19 422 23.8 12,441 19.5 6,806 17.3 Low-birthweight births, as a percent of total births 388 7.4 19,006 8.0 9,150 7.6 Late/no prenatal care, as a percent of total births 286 5.5 13,148 5.6 4,845 4.1 Infant deaths, per 1,000 live births 31 5.9 1,179 5.0 667 5.5 Total hospitalizations, per 10,000 63,331 1,274.6 2,398,679 1,226.2 1,312,126 1,168.1 Preventable hospitalizations, per 10,000 8,922 179.6 293,493 150.0 158,173 140.8 Adult asthma hospitalizations, per 10,000 183 8.8 24,276 15.9 8,931 10.2 Pediatric asthma hospitalizations, per 10,000 64 11.8 11,340 26.6 3,513 14.2 Diabetes hospitalizations, per 10,000 902 18.2 37,847 19.3 17,503 15.6 CLRD hospitalizations, per 10,000 2,206 44.4 71,475 36.5 37,028 33.0 Heart disease hospitalizations, per 10,000 6,284 126.5 212,301 108.5 125,733 111.9 Total ED visits, per 10,000 234,071 4,711.1 7,993,838 4,086.4 4,215,240 3,752.5 Source: New York State Community Health Indicator Reports, 2011-2013 (3- Year Average)

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Primary Care Physicians

There were more than 500 primary care physicians practicing in the Mohawk Valley region. Forty-one percent (41%) were in family or general practice and 34% were in general internal medicine. There were over 80 psychiatrists, including child and adolescent psychiatrists, practicing in the Mohawk Valley region, or approximately 13.7 per 100,000 total population. Otsego County had the highest rate with nearly 106.2 family, general, and internal medicine (general) physicians per 100,000 population, and Herkimer County had the lowest rate with 34.0 per 100,000 (Table 92 and Figure 28).

Table 92. Primary Care Physicians and Psychiatrists in the Mohawk Valley Region, by Specialty, 2015 Per 100,000 Specialty Physicians Populationa Family/General Practice 209 33.7 Internal Medicine (General) 172 27.8 Subtotal 381 61.5 Geriatrics 8 9.7 Obstetrics/Gynecology 52 57.4 Pediatrics (General) 68 65.5 Primary Care Total 510 N/A Psychiatrist 85 13.7 a All rates are per 100,000 total population except the Ob/Gyn rate, which is per 100,000 women aged 15 to 44, the pediatrician rate, which is per 100,000 children aged birth to 17 years, and the geriatrics rate, which is per 100,000 population aged 65 and older. Source: Center for Health Workforce Studies

Figure 28. Number of Selected Primary Care Physicians per 100,000 Population in the Mohawk Valley Region, by County, 2015

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Employment

Total Health Sector Employment

Between 2010 and 2014, health sector employment in the Mohawk Valley region experienced an overall decline of of 948 jobs. Employment in ambulatory care increased by more than 100 jobs, or by 2%, whereas jobs in nursing home and personal care facilities grew by 1%, adding 60 jobs. In contrast, employment in hospitals fell by over 1,000 jobs, or 9%, and employment in home health care declined nearly 4% during the same period (Table 93).

Table 93. Number of Health Care Jobs in the Mohawk Valley Region, by Setting, 2010-2014 Change Between Setting 2010 2011 2012 2013 2014 2010 and 2014 Number Percent Hospitals 12,501 12,359 12,153 12,069 11,435 -1,066 -8.5% Ambulatory care 6,646 6,635 6,757 6,753 6,755 109 1.6% (excluding home health) Nursing home and personal 6,632 6,561 6,555 6,693 6,692 60 0.9% care facilities Home health care 1,416 1,464 1,396 1,390 1,365 -51 -3.6% Total 27,195 27,019 26,861 26,905 26,247 -948 -3.5% Source: New York State Department of Labor, ES-202

Employment and Wage by Occupation

Employment for selected health occupations is reported in Table 93. RNs in the Mohawk Valley region accounted for the most jobs in the first quarter of 2015 (4,600), followed by home health aides (4,540) and personal care aides (4,370). Surgical technologists, occupational therapy assistants, cardiovascular technologists and technicians accounted for the fewest jobs at 110, 70, and 60, respectively.

Wages in selected health occupations for Mohawk Valley are reported in Table 94. These wages were based on 2012-2015 survey data, which was adjusted to include the first quarter of 2016. Pharmacists earned the highest hourly wage in 2016 ($61.14), followed by PAs ($49.22). Personal care aides were the lowest wage earners ($12.42), followed by home health aides ($12.80) in the Mohawk Valley region.

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Table 94. Number of Jobs in Selected Health Occupations in the Mohawk Valley Region, 2015 Occupation Employment Registered Nurses 4,600 Home Health Aides 4,540 Personal Care Aides 4,370 Nursing Assistants 3,040 Licensed Practical and Licensed Vocational Nurses 1,970 Social Workers 1,240 Medical and Health Services Managers 580 Pharmacists 560 Pharmacy Technicians 530 Dental Assistants 350 Radiologic Technologists and Technicians 340 Medical Assistants 340 Nurse Practitioners 320 Medical Records and Health Information Technicians 290 Physical Therapists 260 Medical Secretaries 250 Dental Hygienists 240 Physician Assistants 230 Medical and Clinical Laboratory Technologists 230 Speech-Language Pathologists 210 Occupational Therapists 190 Physical Therapist Assistants 180 Mental Health Counselors 160 Respiratory Therapists 140 Medical and Clinical Laboratory Technicians 130 Dietitians and Nutritionists 120 Surgical Technologists 110 Occupational Therapy Assistants 70 Cardiovascular Technologists and Technicians 60 Source: New York State Department of Labor, Bureau of Labor Statistics, Occupational Wages

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Table 95. Average Hourly Wage in Selected Health Occupations in the Mohawk Valley Region, 2016 Average Wage Occupation per Hour Pharmacists $61.14 Physician Assistants $49.22 Nurse Practitioners $46.53 Medical and Health Services Managers $46.41 Nuclear Medicine Technologists $38.00 Physical Therapists $35.54 Occupational Therapists $35.13 Speech-Language Pathologists $33.28 Dental Hygienists $33.20 Respiratory Therapists $30.35 Registered Nurses $29.84 Medical and Clinical Laboratory Technologists $29.75 Radiologic Technologists and Technicians $29.35 Dietitians and Nutritionists $28.97 Social Workers $26.91 Mental Health Counselors $24.08 Cardiovascular Technologists and Technicians $23.52 Occupational Therapy Assistants $21.24 Surgical Technologists $21.00 Physical Therapist Assistants $20.56 Medical and Clinical Laboratory Technicians $20.12 Dietetic Technicians $19.22 Licensed Practical and Licensed Vocational Nurses $18.45 Medical Records and Health Information Technicians $17.76 Dental Assistants $15.95 Medical Assistants $15.38 Physical Therapist Aides $14.37 Medical Secretaries $13.70 Pharmacy Technicians $13.33 Nursing Assistants $13.10 Home Health Aides $12.80 Personal Care Aides $12.42 Source: New York State Department of Labor, Labor Statistics, Occupational Wages

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Licensed Health Professionals

Between 2010 and 2014, the number of licensed RNs in the Mohawk Valley region increased by nearly than 200, or 4%. NPs experienced the highest percentage growth (19%), followed by respiratory therapists (18%), and PAs (17%). In contrast, the number of occupational therapy assistants and clinical laboratory technicians experienced declines between 2010 and 2014 in the Mohawk Valley region (Table 96).

Table 96. Number of Licensed Individuals in Selected Health Occupations in the Mohawk Valley Region, 2010-2014 Change Between Profession 2010 2011 2012 2013 2014 2010 and 2014 Number Percent Registered Nurses 6,786 6,832 6,978 7,137 7,021 235 3.5% Licensed Practical Nurses 3,505 3,579 3,533 3,518 3,506 1 0.0% Social Workers 640 681 666 680 702 62 9.7% Pharmacists 480 498 519 528 542 62 12.9% Physical Therapists 341 339 357 378 385 44 12.9% Nurse Practitioners 402 418 428 468 479 77 19.2% Speech-Language Pathologists 223 225 227 238 238 15 6.7% Clinical Laboratory Technologists 343 332 341 342 350 7 2.0% Physician Assistants 182 192 194 207 212 30 16.5% Occupational Therapists 309 320 328 331 342 33 10.7% Dental Hygienists 265 283 289 289 295 30 11.3% Respiratory Therapists 186 194 205 215 220 34 18.3% Physical Therapist Assistants 210 204 205 221 217 7 3.3% Dietitians/Nutritionists 89 90 94 92 96 7 7.9% Occupational Therapy Assistants 157 153 154 146 141 -16 -10.2% Clinical Laboratory Technicians 87 77 74 73 72 -15 -17.2% Source: New York State Education Department, Office of Professions

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Demand for Health Workers

Hospitals

Hospitals in the Mohawk Valley region reported that newly licensed RNs posed the most difficulty to recruit, followed by experienced RNs and nurse managers. Experienced RNs and newly licensed RNs were also the most difficult to retain, followed by medical coders and psychologists (Table 97).

Table 97. Recruitment and Retention Difficulties for Hospitals in Selected Health Occupations in the Mohawk Valley Region, 2016 Average Assessment of Percentage of Respondents Difficulty Indicating Reasons for Difficulties Occupation Shortage Salary Geographic Recruitment Retention of Levels Location Workers Experienced Registered Nurses 4.4 3.8 80% 60% 100% Newly Licensed Registered Nurses 4.5 3.8 60% 20% 80% Nurse Managers 4.0 2.8 60% 40% 80% CNA/Patient Care Techs 3.2 2.4 60% 0% 20% Nurse Practitioners 2.3 2.8 40% 20% 40% Physician Assistants 1.5 1.5 0% 0% 0% Pharmacists 2.2 2.0 20% 0% 20% Clinical Lab Technicians 2.5 2.0 20% 0% 20% Clinical Lab Technologists 3.6 2.6 60% 0% 20% Medical Hospital Coders 3.2 3.0 60% 40% 20% Occupational Therapists 2.6 2.6 40% 0% 20% Care Coordinators 1.8 2.0 0% 0% 0% Case Managers 2.8 2.0 40% 0% 20% Care Managers 1.8 1.8 0% 0% 0% Patient Navigators 1.4 1.4 0% 0% 0% Community Health Workers 1.5 1.4 0% 0% 0% Psychologists 3.0 3.0 20% 20% 20% Psychiatric NPs 3.0 2.5 40% 20% 40% Licensed Clinical Social Workers 2.5 2.0 20% 0% 0% Licensed Master Social Workers 2.0 2.0 20% 0% 0% Licensed Mental Health Counselors 3.0 1.0 20% 0% 0%

• Many hospitals projected growth in inpatient services, with increasing demand for nurse managers (40%), care managers (60%), and care coordinators (40%). • Many hospitals projected growth in outpatient services, with increasing demand for occupational therapists (40%), RNs (40%), and patient navigators (40%).

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Nursing Homes

Nursing homes in the Mohawk Valley region reported the most difficulty recruiting experienced RNs, followed by MDS coordinators and nurse managers. CNAs were the most difficult to retain, followed by dietary aides, experienced RNs, and housekeeping staff (Table 98).

Table 98. Recruitment and Retention Difficulties for Nursing Homes in Selected Health Occupations in the Mohawk Valley Region, 2016 Average Assessment of Percentage of Respondents Indicating Difficulty Reasons for Difficulties Occupation Shortage Salary Recruitment Retention of Benefits Location Levels Workers Activities Director 2.0 1.7 0% 0% 14% 0% Certified Nurse Aides/Assts. (CNAs) 2.9 3.9 67% 33% 0% 33% Dietary Aides 2.1 3.4 29% 43% 0% 14% Dietitians/Nutritionists 2.5 2.2 0% 20% 0% 0% Housekeeping Staff 2.5 3.3 25% 13% 0% 38% Licensed Practical Nurses 3.0 3.1 33% 11% 0% 22% Medical Billers 2.7 2.3 17% 0% 0% 0% Occupational Therapists 2.8 2.7 17% 0% 0% 17% Occupational Therapy Assistants 2.7 2.3 0% 0% 0% 14% Physical Therapists 3.0 2.4 14% 14% 0% 14% Physical Therapist Assistants 3.0 2.3 0% 0% 0% 13% Registered Nurses (RNs) Newly Licensed RNs 3.3 3.0 71% 14% 0% 29% Experienced RNs 3.7 3.4 56% 11% 0% 33% MDS Coordinators 3.4 2.7 57% 0% 0% 43% Nurse Manager 3.4 2.7 44% 0% 0% 33% Director of Nursing 3.1 2.6 29% 0% 0% 29% Recreational Therapists 2.8 2.3 25% 0% 0% 0% Respiratory Therapists 2.5 2.3 50% 0% 0% 25% Social Workers (SWs) Licensed Clinical SWs 3.0 2.7 17% 0% 0% 33% Licensed Master SWs 3.2 2.8 17% 0% 0% 17% Speech-Language Pathologists 3.0 3.0 40% 0% 0% 20%

• Forty-four percent (44%) of nursing homes reported difficulty hiring part-time workers. • Fifty-six percent (56%) of nursing homes indicated difficulty hiring workers for off shifts (evenings, nights, and weekends).

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Home Health Care Agencies

Responses rates to employer demand surveys were too low in the Central New York and Mohawk Valley, so survey responses were combined. Home health care agencies in these two regions reported the most difficulty recruiting homemakers, followed by occupational therapists and personal care aides. Similarly, respondents reported difficulty retaining personal care aides (Table 98).

Table 98. Recruitment and Retention Difficulties for Home Health Care Agencies in Selected Health Occupations in the Central New York and Mohawk Valley Regions, 2016 Average Assessment of Percentage of Respondents Indicating Reasons Difficulty for Difficulties Non- Occupation Lack of Competitive Recruitment Retention Shortage Specialized Location Salaries/ Training Benefits Home Health Aides 3.4 3.0 0% 20% 0% 40% Homemakers 5.0 2.0 0% 0% 0% 0% Personal Care Aides 4.0 3.3 0% 33% 0% 33% Dietitians/Nutritionists 3.5 2.0 0% 0% 0% 0% Licensed Practical Nurses 2.4 2.0 0% 20% 0% 0% Occupational Therapists 4.5 2.0 0% 50% 0% 0% Physical Therapists 3.0 2.0 50% 50% 0% 50% Registered Nurses Newly Licensed RNs 3.3 3.0 0% 0% 0% 0% Experienced RNs 3.7 3.0 17% 33% 17% 17% Respiratory Therapists N/A N/A N/A N/A N/A N/A Social Workers (SWs) Licensed Clinical SWs 2.0 2.0 0% 0% 0% 0% Licensed Master SWs 3.0 2.5 20% 0% 0% 0% Speech-Language Pathologists N/A N/A N/A N/A N/A N/A

• Two-thirds (67%) of home health care agencies indicated difficulty hiring workers for off shifts (evenings, nights, and weekends). • One-third (33%) of home health care agencies indicated difficulty hiring part-time workers. • Two-thirds of the respondents indicated that they would be expanding services within the next year.

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FQHCs The North Country and Mohawk Valley regions were combined due to low survey response rates. FQHCs in these regions had the most difficulty recruiting substance abuse counselors, followed by psychiatric NPs and dentists. FQHCs in these regions had the most difficulty retaining psychiatric NPs (Table 100).

Table 100. Recruitment and Retention Difficulties for FQHCs in Selected Health Occupations in the Mohawk Valley and North Country Regions, 2016 Average Assessment of Difficulty Occupation Recruitment Retention Family/General Practice 4.0 3.4 Internal Medicine 4.0 3.7 Physicians Ob/Gyn 3.0 2.0 Pediatricians 4.0 3.5 Physician Assistants (PAs) 2.8 3.0 Overall – All Specialties 3.3 3.3 Pediatric 3.0 2.0 Nurse Practitioners Adult 3.0 2.0 Family 3.0 3.3 Psychiatric 4.3 4.0 Registered Nurses 3.8 3.3 Nurses Licensed Practical Nurses 3.6 3.0 Psychiatrists 3.5 3.5 Psychologists 3.0 2.0 Behavioral Health Substance Abuse Counselors 5.0 2.5 Social Workers 4.0 3.3 Dentists 4.2 3.5 Oral Health Dental Hygienists 2.4 2.5 Care Coordinators 3.0 3.0 Coordination/Patient Case Managers 2.3 2.5 Care HIV Counselors 4.0 3.0 Community Health Workers 4.0 3.0 Patient/Community Patient Health Educators 4.0 3.0 Education Nutritionists/Nutrition Educators 2.5 2.5 Patient Health Navigators 4.0 3.0 Outreach Workers 3.0 2.5 Enabling Services Transportation Workers 4.0 2.0 Interpreters 4.0 2.0 Administrative Support IT Systems Admin/Maintenance 2.5 1.5 Physical Therapists 1.0 1.0 Others Occupational Therapists 0.0 0.0

• Eighty-three percent (83%) of FQHCs in these regions anticipated expanding one or more service.

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Employment Projections by Health Occupation

According to the NYSDOL, the largest numbers of average annual job openings projected in the Mohawk Valley region between 2012 and 2022 will be for personal care aides (160), RNs (150), home health aides (100), and nursing assistants (100), (Table 101).

Table 101. Employment Projections for Selected Health Occupations in the Mohawk Valley Region, 2012 and 2022 Change Between Average Occupation 2012 2022 2012 and 2022 Annual Number Percent Openingsa Personal Care Aides 4,290 5,560 1,270 29.6% 160 Registered Nurses 4,770 5,350 580 12.2% 150 Home Health Aides 2,480 3,030 550 22.2% 100 Nursing Assistants 3,390 3,780 390 11.5% 100 Licensed Practical and Licensed Vocational 2,170 2,520 350 16.1% 90 Emergency Medical Technicians and Paramedics 530 710 180 34.0% 30 Physical Therapists 500 610 110 22.0% 20 Medical and Health Services Managers 750 850 100 13.3% 30 Nurse Practitioners 280 380 100 35.7% 20 Diagnostic Medical Sonographers 180 260 80 44.4% 10 Medical Assistants 290 370 80 27.6% 20 Social Workers 1,200 1,270 70 5.8% 40 Physician Assistants 180 250 70 38.9% 10 Radiologic Technologists 410 470 60 14.6% 20 Pharmacy Technicians 540 600 60 11.1% 20 Occupational Therapists 270 320 50 18.5% 0 Respiratory Therapists 230 270 40 17.4% 0 Medical Records and Health Info Techs 250 290 40 16.0% 10 Dietitians and Nutritionists 140 170 30 21.4% 0 Pharmacists 470 500 30 6.4% 10 Dental Hygienists 300 330 30 10.0% 10 Dental Assistants 380 410 30 7.9% 10 Speech-Language Pathologists 270 290 20 7.4% 0 Medical and Clinical Laboratory Technologists 170 190 20 11.8% 0 Medical and Clinical Laboratory Technicians 70 90 20 28.6% 0 Surgical Technologists 80 100 20 25.0% 0 Orderlies 110 130 20 18.2% 0 Cardiovascular Technologists & Technicians 70 80 10 14.3% 0 Clinical, Counseling, and School Psychologists 310 310 0 0.0% 10 Psychiatric Aides 430 410 -20 -4.7% 10 a Annual openings reflect creation of new positions in the occupation and replacement for those retiring or otherwise leaving the profession. Source: New York State Department of Labor, Jobs in Demand/Projects, Long-Term Occupation Projections, 2012-2022

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H. North Country The North Country includes the counties of Clinton, Essex, Franklin, Hamilton, Jefferson, Lewis, and Saint Lawrence.

Population

The North Country region was much less racially and ethnically diverse compared with New York as a whole. Additionally, the region had a slightly greater percentage of people under 200% of the FPL compared with the statewide average. A higher percentage of the North Country region population had a high school diploma or equivalent, or associate degrees, but a much smaller percentage held a bachelor’s degree or higher than the state as a whole (Table 102).

Table 102. Selected Population Characteristics in the North Country Region, 2010-2014 (5-Year Average) Region Statewide Population Characteristicsa Number Percent Percent Total population 435,256 N/A N/A Population under 100% FPL 65,057 14.9% 15.2% Population under 200% FPL 144,701 33.2% 31.7% Population aged birth to 17 years 93,388 21.5% 21.8% Population aged 65 and older 61,990 14.2% 14.1% Population female aged 15 to 44 80,814 18.6% 20.7% Women aged 15 to 19 who had a birth in past 12 mos. 260 0.1% 0.05% Women aged 20 to 34 who had a birth in past 12 mos. 4,237 1.0% 0.8% Women aged 35 to 50 who had a birth in past 12 mos. 752 0.2% 0.3% Black/African American, non-Hispanic 15,667 3.6% 14.4% Hispanic/Latino 15,499 3.6% 18.2% Asian/Pacific Islander, non-Hispanic 4,870 1.1% 7.7% American Indian/Native Alaskan, non-Hispanic 5,269 1.2% 0.2% Two or more/other 8,000 1.8% 2.2% Less than high school education 37,313 12.9% 14.6% High school or equivalent 159,415 55.3% 43.2% Associate degree 31,703 11.0% 8.5% Bachelor's degree 32,283 11.2% 19.1% Master's degree or higher 27,629 9.6% 14.6% a Education levels and rates are based on individuals aged 25 years and older. Source: US Census, American Community Survey, 2010-2014 (5-Year Average)

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Health Status

The North Country region had a higher rate of deaths due to diabetes but a slightly lower rate of death due to heart disease than the state as a whole. The North Country also had higher rates of hospitalizations due to chronic lower respiratory disease, but had lower rates for diabetes hospitalizations than upstate New York and the state as a whole. The North Country had substantially higher rates of ED visits than statewide or upstate New York (Table 103).

Table 103. Selected Health Indicators in the North Country Region, 2011-2013 (3-Year Average) Region Upstate Statewide Health Indicator Number Rate Number Rate Number Rate Total deaths, per 100,000 3,669 842.4 95,944 854.1 147,313 753.1 Deaths due to heart disease, per 100,000 928 213.0 26,818 238.7 43,448 222.1 Deaths due to all cancers, per 100,000 866 199.0 22,723 202.4 35,215 180.7 Deaths due to diabetes, per 100,000 113 25.9 2,198 19.6 3,975 20.3 Total births, per 1,000 females aged 15 to 44 5,410 66.8 120,237 56.8 238,078 59.0 Teen births, per 1,000 females aged 15 to 19 381 26.0 6,806 17.3 12,441 19.5 Low-birthweight births, as a percent of total births 389 7.3 9,150 7.6 19,006 8.0 Late/no prenatal care, as a percent of total births 188 3.5 4,845 4.1 13,148 5.6 Infant deaths, per 1,000 live births 37 6.8 667 5.5 1,179 5.0 Total hospitalizations, per 10,000 48,250 1,107.9 1,312,126 1,168.1 2,398,679 1,226.2 Preventable hospitalizations, per 10,000 6,464 148.4 158,173 140.8 293,493 150.0 Adult asthma hospitalizations, per 10,000 244 9.9 8,931 10.2 24,276 15.9 Pediatric asthma hospitalizations, per 10,000 4 5.6 3,513 14.2 11,340 26.6 Diabetes hospitalizations, per 10,000 632 14.5 17,503 15.6 37,847 19.3 CLRD hospitalizations, per 10,000 1,722 39.5 37,028 33.0 71,475 36.5 Heart disease hospitalizations, per 10,000 4,561 104.7 125,733 111.9 212,301 108.5 Total ED visits, per 10,000 226,149 5,193.0 4,215,240 3,752.5 7,993,838 4,086.4 Source: New York State Community Health Indicator Reports, 2011-2013 (3- Year Average)

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Primary Care Physicians

There were 409 primary care physicians practicing in the North Country region. Forty-three percent (43%) were in family or general practice and 30% were in general internal medicine. There were over 60 psychiatrists, including child and adolescent psychiatrists, practicing in the North Country region, or approximately 15.1 per 100,000. Hamilton County had the highest rate with nearly 114.3 family, general, and internal medicine (general) physicians per 100,000 population, and Jefferson County had the lowest rate with 40.2 per 100,000 (Table 104 and Figure 29).

Table 104. Primary Care Physicians and Psychiatrists in the North Country Region, by Specialty, 2015 Per 100,000 Specialty Physicians Populationa Family/General Practice 174 39.9 Internal Medicine (General) 123 28.3 Subtotal 297 68.2 Geriatrics 3 4.4 Obstetrics/Gynecology 46 57.5 Pediatrics (General) 63 67.3 Primary Care Total 409 N/A Psychiatrist 66 15.1 a All rates are per 100,000 total population except the Ob/Gyn rate, which is per 100,000 women aged 15 to 44, the pediatrician rate, which is per 100,000 children aged birth to 17 years, and the geriatrics rate, which is per 100,000 population aged 65 and older. Source: Center for Health Workforce Studies

Figure 29. Number of Selected Primary Care Physicians per 100,000 Population in the North Country Region, by County, 2015

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Employment

Total Health Sector Employment

Total health sector employment in the North Country region grew by nearly 4% between 2010 and 2014, adding just over 650 jobs. Employment in home health care grew by over 300 jobs (57.3%), and jobs in nursing home and personal care facilities increased by 126 (4%). In contrast, there was a decline in hospital jobs by over 30 positions, or 0.4%, during the same period (Table 105).

Table 105. Number of Health Care Jobs in the North Country Region, by Setting, 2010-2014 Change Between Setting 2010 2011 2012 2013 2014 2010 and 2014 Number Percent Hospitals 8,991 9,190 9,251 8,982 8,957 -34 -0.4% Ambulatory care 5,103 5,137 5,180 3,040 5,358 255 5.0% (excluding home health) Nursing home and personal 2,937 2,920 2,937 5,286 3,063 126 4.3% care facilities Home health care 532 538 531 589 837 305 57.3% Total 17,564 17,784 17,899 17,897 18,215 651 3.7% Source: New York State Department of Labor, ES-202

Employment and Wage by Occupation

Employment for selected health occupations is reported in Table 105. RNs in the North Country region accounted for the most jobs in the first quarter of 2015 (3,540), followed by personal care aides (3,320) and nursing assistants (2,440). Occupational therapy assistants (40), dietetic technicians (30), and orderlies (20) had the fewest jobs among the selected health occupations.

Wages in selected health occupations for the North Country region are reported in Table 106. These wages were based on 2012-2015 survey data, which were adjusted to include the first quarter of 2016. Pharmacists earned the highest hourly wage in 2016 ($61.11), followed by physician assistants ($55.37) and medical and health services managers ($50.51). Home health aides ($11.68) and orderlies ($10.50) were the lowest wage earners for the selected health occupations in the North Country region.

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Table 106. Number of Jobs in Selected Health Occupations in the North Country Region, 2015 Occupation Employment Registered Nurses 3,540 Personal Care Aides 3,320 Nursing Assistants 2,440 Licensed Practical and Licensed Vocational Nurses 1,720 Home Health Aides 1,250 Social Workers 880 Medical and Health Services Managers 400 Pharmacists 370 Physical Therapists 370 Pharmacy Technicians 340 Dental Assistants 310

Dental Hygienists 300 Physician Assistants 270 Nurse Practitioners 230 Speech-Language Pathologists 230 Radiologic Technologists and Technicians 230 Occupational Therapists 190 Medical Assistants 190 Medical and Clinical Laboratory Technologists 160 Medical Records and Health Information Technicians 160 Medical Secretaries 140 Respiratory Therapists 100 Physical Therapist Assistants 100 Dietitians and Nutritionists 90 Surgical Technologists 80 Medical and Clinical Laboratory Technicians 80 Mental Health Counselors 70 Cardiovascular Technologists and Technicians 50 Nuclear Medicine Technologists 40 Occupational Therapy Assistants 40 Dietetic Technicians 30 Orderlies 20 Source: New York State Department of Labor, Bureau of Labor Statistics, Occupational Wages

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Table 107. Average Hourly Wage in Selected Health Occupations in the North Country Region, 2016 Average Wage Occupation per Hour Pharmacists $61.11 Physician Assistants $55.37 Medical and Health Services Managers $50.51 Nurse Practitioners $44.64 Nurse Midwives $43.37 Speech-Language Pathologists $37.93 Physical Therapists $34.82 Occupational Therapists $32.74 Nuclear Medicine Technologists $32.05 Registered Nurses $32.04 Medical and Clinical Laboratory Technologists $30.50 Dental Hygienists $30.42 Respiratory Therapists $29.98 Dietitians and Nutritionists $28.59 Radiologic Technologists and Technicians $27.21 Cardiovascular Technologists and Technicians $26.75 Social Workers $23.77 Mental Health Counselors $23.52 Medical and Clinical Laboratory Technicians $22.89 Surgical Technologists $22.02 Physical Therapist Assistants $21.29 Occupational Therapy Assistants $21.25 Dietetic Technicians $20.07 Medical Records and Health Information Technicians $19.05 Licensed Practical and Licensed Vocational Nurses $18.77 Occupational Therapy Aides $15.47 Medical Secretaries $15.33 Medical Assistants $15.20 Dental Assistants $15.11 Pharmacy Technicians $14.09 Nursing Assistants $12.89 Personal Care Aides $12.84 Physical Therapist Aides $12.57 Home Health Aides $11.68 Orderlies $10.50 Source: New York State Department of Labor, Labor Statistics, Occupational Wages

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Licensed Health Professionals

Between 2010 and 2014, the number of licensed RNs in the North Country region increased by more than 300, or 7%. NPs (38%) experienced the highest percentage increase in the region, followed by respiratory therapists (30%), pharmacists (18%), and social workers (18%) during the same period. The number of both clinical laboratory technician and occupational therapy assistants declined in the North Country region, falling by 21% and 6%, respectively (Table 108).

Table 108. Number of Licensed Individuals in Selected Health Occupations in the North Country Region, 2010-2014 Change Between Profession 2010 2011 2012 2013 2014 2010 and 2014 Number Percent Registered Nurses 5,082 5,165 5,260 5,494 5,413 331 6.5% Licensed Practical Nurses 2,591 2,674 2,679 2,740 2,700 109 4.2% Social Workers 375 383 397 414 443 68 18.1% Pharmacists 336 346 366 396 397 61 18.2% Physical Therapists 301 301 316 329 327 26 8.6% Nurse Practitioners 226 238 260 289 311 85 37.6% Speech-Language Pathologists 226 237 252 256 262 36 15.9% Clinical Laboratory Technologists 245 249 259 257 250 5 2.0% Physician Assistants 191 200 211 226 250 59 30.9% Occupational Therapists 132 136 139 148 153 21 15.9% Dental Hygienists 225 235 240 245 241 16 7.1% Respiratory Therapists 69 79 81 88 90 21 30.4% Physical Therapist Assistants 151 151 157 165 173 22 14.6% Dietitians/Nutritionists 80 81 81 82 86 6 7.5% Occupational Therapy Assistants 84 82 85 84 79 -5 -6.0% Clinical Laboratory Technicians 77 72 70 63 61 -16 -20.8% Source: New York State Education Department, Office of Professions

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Demand for Health Workers

Hospitals

Hospitals in the North Country region had the most difficulty recruiting clinical laboratory technologists, followed by nurse managers, nurse practitioners, and psychiatric NPs. Clinical lab technologists and CNAs were the most difficult to retain in hospitals across the region, followed by licensed clinical social workers and licensed master social workers (Table 109).

Table 109. Recruitment and Retention Difficulties for Hospitals in Selected Health Occupations in the North Country Region, 2016 Average Assessment of Percentage of Respondents Difficulty Indicating Reasons for Difficulties Occupation Shortage Salary Geographic Recruitment Retention of Levels Location Workers Experienced Registered Nurses 3.3 2.2 56% 11% 33% Newly Licensed Registered Nurses 1.8 2.0 11% 0% 33% Nurse Managers 4.0 2.3 44% 11% 56% CNA/Patient Care Techs 2.3 3.2 22% 22% 22% Nurse Practitioners 4.0 2.0 44% 11% 56% Physician Assistants 3.7 2.0 44% 0% 44% Pharmacists 2.8 1.7 11% 0% 22% Clinical Lab Technicians 3.5 2.8 56% 22% 33% Clinical Lab Technologists 4.7 3.2 56% 22% 44% Medical Hospital Coders 3.2 1.8 11% 0% 11% Occupational Therapists 3.5 2.4 44% 11% 44% Care Coordinators 2.0 1.5 11% 0% 11% Case Managers 1.8 1.6 0% 0% 0% Care Managers 2.0 1.5 0% 0% 0% Patient Navigators 2.0 1.4 11% 11% 11% Community Health Workers 1.8 1.5 11% 0% 11% Psychologists 2.8 2.5 11% 0% 11% Psychiatric NPs 4.0 3.0 44% 11% 33% Licensed Clinical Social Workers 2.6 3.0 44% 0% 22% Licensed Master Social Workers 3.0 3.0 22% 0% 22% Licensed Mental Health Counselors 2.0 2.3 11% 0% 11%

• Many hospitals projected growth in inpatient services, with increasing demand for care coordinators (33%), CNAs (33%), and NPs (22%). • Many hospitals projected growth in outpatient services, with increasing demand for CNAs (56%), NPs (56%), and medical coders (44%).

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Nursing Homes

Nursing homes in the North Country region reported the most difficulty recruiting occupational therapists, followed by experienced RNs, occupational therapy assistants, and physical therapists. Speech-language pathologists were cited as the most difficult to retain, followed CNAs, occupational therapists, occupational therapy assistants, physical therapists, and physical therapist assistants (Table 110).

Table 110. Recruitment and Retention Difficulties for Nursing Homes in Selected Health Occupations in the North Country Region, 2016 Average Assessment of Percentage of Respondents Indicating Difficulty Reasons for Difficulties Occupation Shortage Salary Recruitment Retention of Benefits Location Levels Workers Activities Director 2.8 1.0 0% 0% 0% 0% Certified Nurse Aides/Assts. (CNAs) 3.8 4.0 83% 17% 0% 17% Dietary Aides 2.3 2.0 0% 0% 0% 20% Dietitians/Nutritionists 3.8 2.5 50% 0% 0% 75% Housekeeping Staff 2.0 2.0 0% 25% 0% 0% Licensed Practical Nurses 3.3 3.0 50% 33% 17% 0% Medical Billers 3.0 2.5 0% 0% 0% 0% Occupational Therapists 4.5 4.0 75% 0% 0% 50% Occupational Therapy Assistants 4.3 4.0 67% 33% 0% 67% Physical Therapists 4.3 4.0 67% 0% 0% 67% Physical Therapist Assistants 4.0 4.0 50% 0% 0% 25% Registered Nurses (RNs) Newly Licensed RNs 3.7 3.8 25% 25% 25% 0% Experienced RNs 4.4 3.8 60% 40% 20% 20% MDS Coordinators 3.0 3.0 0% 0% 0% 0% Nurse Manager 3.8 3.5 60% 40% 20% 0% Director of Nursing 3.0 1.0 0% 0% 0% 0% Recreational Therapists 2.0 2.0 0% 0% 0% 0% Respiratory Therapists 3.3 3.3 33% 0% 0% 33% Social Workers (SWs) Licensed Clinical SWs 2.0 2.0 0% 0% 0% 0% Licensed Master SWs 3.0 3.0 0% 0% 0% 0% Speech-Language Pathologists 4.0 4.3 67% 0% 0% 33%

• Seventeen percent (17%) of nursing homes reported difficulty hiring part-time workers. • Eighty-three percent (83%) of nursing homes indicated difficulty hiring workers for off shifts (evenings, nights, and weekends).

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Home Health Care Agencies

Home health care agencies in the North Country region reported difficulty recruiting occupational therapists, experienced RNs, speech-language pathologists, and, homemakers. Newly licensed RNs and respiratory therapists were the most difficult to retain, followed by experienced RNs (Table 111).

Table 111. Recruitment and Retention Difficulties for Home Health Care Agencies in Selected Health Occupations in the North Country Region, 2016 Average Assessment of Percentage of Respondents Indicating Reasons Difficulty for Difficulties Non- Occupation Lack of Competitive Recruitment Retention Shortage Specialized Location Salaries/ Training Benefits Home Health Aides 4.2 3.6 60% 40% 20% 50% Homemakers 4.5 3.0 0% 0% 0% 0% Personal Care Aides 4.0 3.3 33% 33% 33% 0% Dietitians/Nutritionists 3.8 3.0 0% 0% 0% 0% Licensed Practical Nurses 2.8 2.4 0% 40% 20% 0% Occupational Therapists 4.6 3.3 0% 50% 50% 50% Physical Therapists 3.7 2.7 50% 67% 17% 33% Registered Nurses Newly Licensed RNs 4.2 4.0 40% 50% 25% 50% Experienced RNs 4.6 3.9 63% 75% 25% 38% Respiratory Therapists 4.0 4.0 50% 50% 50% 50% Social Workers Licensed Clinical SWs 3.8 2.8 25% 0% 0% 25% Licensed Master SWs 3.8 3.0 50% 33% 33% 33% Speech-Language Pathologists 4.6 3.8 60% 60% 40% 60%

• Eighty-six percent (86%) of home health agencies reported difficulty hiring part-time workers. • Twenty-nine percent (29%) of home health agencies reported difficulty hiring bilingual workers. • Fifty-seven percent (57%) of home health agencies indicated difficulty hiring workers for off shifts (evenings, nights, and weekends). • Half of the home health agencies in the North Country expected to expand services within the next year.

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FQHCs The North Country and Mohawk Valley regions were combined due to low response rates to the recruitment and retention survey. FQHCs in these combined regions had the most difficulty recruiting substance abuse counselors, and retaining psychiatric NPs, pediatricians, and psychiatrists (Table 112).

Table 112. Recruitment and Retention Difficulties for FQHCs in Selected Health Occupations in the, Mohawk Valley and North Country Regions, 2016 Average Assessment of Difficulty Occupation Recruitment Retention Family/General Practice 4.0 3.4 Internal Medicine 4.0 3.7 Physicians Ob/Gyn 3.0 2.0 Pediatricians 4.0 3.5 Physician Assistants (PAs) 2.8 3.0 Overall – All Specialties 3.3 3.3 Pediatric 3.0 2.0 Nurse Practitioners Adult 3.0 2.0 Family 3.0 3.3 Psychiatric 4.3 4.0 Registered Nurses 3.8 3.3 Nurses Licensed Practical Nurses 3.6 3.0 Psychiatrists 3.5 3.5 Psychologists 3.0 2.0 Behavioral Health Substance Abuse Counselors 5.0 2.5 Social Workers 4.0 3.3 Dentists 4.2 3.5 Dental Hygienists 2.4 2.5 Oral Health Case Managers 2.3 2.5 HIV Counselors 4.0 3.0 Community Health Workers 4.0 3.0 Patient/Community Patient Health Educators 4.0 3.0 Education Nutritionists/Nutrition Educators 2.5 2.5 Patient Health Navigators 4.0 3.0 Outreach Workers 3.0 2.5 Enabling Services Transportation Workers 4.0 2.0 Interpreters 4.0 2.0 Administrative Support IT Systems Admin/Maintenance 2.5 1.5 Physical Therapists 1.0 1.0 Others Occupational Therapists 0.0 0.0

• Eighty-three percent (83%) of FQHCs in these regions anticipated expanding one or more service.

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Employment Projections by Health Occupation

According to the NYSDOL, the largest numbers of average annual job openings projected in the North Country region between 2012 and 2022 will be for personal care aides (100), RNs (100), home health aides (60), nursing assistants (60), and LPNs (60) (Table 113).

Table 113. Employment Projections for Selected Health Occupations in the North Country Region, 2012-2022 Change Between Average Occupation 2012 2022 2012 and 2022 Annual Number Percent Openingsa Personal Care Aides 2,940 3,720 780 26.5% 100 Home Health Aides 1,440 1,780 340 23.6% 60 Registered Nurses 3,730 4,010 280 7.5% 100 Nursing Assistants 1,960 2,180 220 11.2% 60 Licensed Practical and Licensed Vocational 1,580 1,740 160 10.1% 60 Social Workers 680 740 60 8.8% 10 Emergency Medical Technicians and 250 310 60 24.0% 20 Pharmacy Technicians 350 410 60 17.1% 10 Medical and Health Services Managers 500 550 50 10.0% 10 Physical Therapists 270 320 50 18.5% 20 Medical Assistants 290 340 50 17.2% 10 Speech-Language Pathologists 230 270 40 17.4% 0 Dental Hygienists 230 270 40 17.4% 10 Pharmacists 380 410 30 7.9% 10 Physician Assistants 190 220 30 15.8% 0 Nurse Practitioners 150 180 30 20.0% 0 Orderlies 220 250 30 13.6% 0 Dental Assistants 410 440 30 7.3% 10 Dietitians and Nutritionists 100 120 20 20.0% 0 Occupational Therapists 160 180 20 12.5% 0 Medical and Clinical Laboratory Technicians 90 110 20 22.2% 0 Diagnostic Medical Sonographers 70 90 20 28.6% 0 Radiologic Technologists 210 230 20 9.5% 0 Surgical Technologists 80 100 20 25.0% 0 Clinical, Counseling, and School Psychologists 270 280 10 3.7% 10 Respiratory Therapists 90 100 10 11.1% 0 Nurse Anesthetists 20 30 10 50.0% 0 Medical and Clinical Laboratory Technologists 220 230 10 4.5% 10 Cardiovascular Technologists & Technicians 60 70 10 16.7% 0 Medical Records and Health Info Techs 220 230 10 4.5% 10 Psychiatric Aides 630 620 -10 -1.6% 10 a Annual openings reflect creation of new positions in the occupation and replacement for those retiring or otherwise leaving the profession. Source: New York State Department of Labor, Jobs in Demand/Projects, Long-Term Occupation Projections, 2012-2022

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I. Southern Tier The Southern Tier region includes the counties of Broome, Chemung, Chenango, Delaware, Schuyler, Steuben, Tioga, and Tompkins.

Population

Between 2010 and 2014, the Southern Tier region was much less racially and ethnically diverse and was older than New York as a whole. The Southern Tier also had a higher percentage of residents with high school diplomas or associate degrees, and a lower percentage of people with a bachelor’s degree or higher, compared with the state overall (Table 114).

Table 114. Selected Population Characteristics in the Southern Tier Region, 2010-2014 (5-Year Average) Region Statewide Population Characteristicsa Number Percent Percent Total population 655,587 N/A N/A Population under 100% FPL 101,987 15.6% 15.2% Population under 200% FPL 219,825 33.5% 31.7% Population aged birth to 17 years 132,703 20.2% 21.8% Population aged 65 and older 106,285 16.2% 14.1% Population female aged 15 to 44 126,229 19.3% 20.7% Women aged 15 to 19 who had a birth in past 12 mos. 339 0.1% 0.05% Women aged 20 to 34 who had a birth in past 12 mos. 6,036 0.9% 0.8% Women aged 35 to 50 who had a birth in past 12 mos. 1,293 0.2% 0.3% Black/African American, non-Hispanic 21,249 3.2% 14.4% Hispanic/Latino 19,524 3.0% 18.2% Asian/Pacific Islander, non-Hispanic 21,567 3.3% 7.7% American Indian/Native Alaskan, non-Hispanic 1,398 0.2% 0.2% Two or more/other 13,683 2.1% 2.2% Less than high school education 45,469 10.4% 14.6% High school or equivalent 223,784 51.2% 43.2% Associate degree 51,347 11.8% 8.5% Bachelor's degree 60,070 13.8% 19.1% Master's degree or higher 55,832 12.8% 14.6% a Education levels and rates are based on individuals aged 25 years and older. Source: US Census, American Community Survey, 2010-2014 (5-Year Average)

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Health Status

The Southern Tier region had higher rates of total deaths, deaths due to heart disease, deaths due to cancer, and deaths due to diabetes than New York as a whole and upstate New York. The Southern Tier region had a lower overall birth rate but had a higher teen birth rate than upstate New York. In addition, the Southern Tier region had higher rates of ED visits and avoidable hospitalizations than the state as a whole or upstate New York. The region had lower rates of adult and pediatric asthma hospitalizations and heart disease hospitalizations than the state as a whole and upstate New York (Table 115).

Table 115. Selected Health Indicators in the Southern Tier Region, 2011-2013 (3-Year Average) Region Upstate Statewide Health Indicator Number Rate Number Rate Number Rate Total deaths, per 100,000 6,254 955.4 95,944 854.1 147,313 753.1 Deaths due to heart disease, per 100,000 1,704 260.3 26,818 238.7 43,448 222.1 Deaths due to all cancers, per 100,000 1,420 216.3 22,723 202.4 35,215 180.7 Deaths due to diabetes, per 100,000 152 23.2 2,198 19.6 3,975 20.3 Total births, per 1,000 females aged 15 to 44 6,647 52.9 120,237 56.8 238,078 59.0 Teen births, per 1,000 females aged 15 to 19 516 20.8 6,806 17.3 12,441 19.5 Low-birthweight births, as a percent of total births 484 7.3 9,150 7.6 19,006 8.0 Late/no prenatal care, as a percent of total births 290 4.4 4,845 4.1 13,148 5.6 Infant deaths, per 1,000 live births 35 5.3 667 5.5 1,179 5.0 Total hospitalizations, per 10,000 70,368 1,075.0 1,312,126 1,168.1 2,398,679 1,226.2 Preventable hospitalizations, per 10,000 9,969 152.3 158,173 140.8 293,493 150.0 Adult asthma hospitalizations, per 10,000 236 6.5 8,931 10.2 24,276 15.9 Pediatric asthma hospitalizations, per 10,000 8 6.7 3,513 14.2 11,340 26.6 Diabetes hospitalizations, per 10,000 947 14.5 17,503 15.6 37,847 19.3 CLRD hospitalizations, per 10,000 2,310 35.3 37,028 33.0 71,475 36.5 Heart disease hospitalizations, per 10,000 6,942 106.0 125,733 111.9 212,301 108.5 Total ED visits, per 10,000 283,398 4,329.5 4,215,240 3,752.5 7,993,838 4,086.4 Source: New York State Community Health Indicator Reports, 2011-2013 (3- Year Average)

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Primary Care Physicians

There were more than 700 primary care physicians practicing in the Southern Tier region. Forty-two percent (42%) were in family or general practice and 37% were in general internal medicine. There were over 100 psychiatrists, including child and adolescent psychiatrists, practicing in the Southern Tier region, or approximately 15.6 per 100,000. Chemung County had the highest rate (120.2) of family, general, and internal medicine (general) physicians per 100,000 population. Tioga County had the lowest rate with 46.1 per 100,000 population (Table 116 and Figure 30).

Table 116. Primary Care Physicians and Psychiatrists in the Southern Tier Region, by Specialty, 2015 Per 100,000 Specialty Physicians Populationa Family/General Practice 298 45.5 Internal Medicine (General) 261 39.8 Subtotal 559 85.3 Geriatrics 7 6.4 Obstetrics/Gynecology 66 52.0 Pediatrics (General) 83 62.8 Primary Care Total 715 N/A Psychiatrist 103 15.6 a All rates are per 100,000 total population except the Ob/Gyn rate, which is per 100,000 women aged 15 to 44, the pediatrician rate, which is per 100,000 children aged birth to 17 years, and the geriatrics rate, which is per 100,000 population aged 65 and older. Source: Center for Health Workforce Studies

Figure 30. Number of Selected Primary Care Physicians per 100,000 Population in the Southern Tier Region, by County, 2015

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Employment

Total Health Sector Employment

Between 2010 and 2014, health sector employment throughout the Southern Tier region remained stable. Employment in hospitals had the largest percentage increase, growing by 453 jobs, or nearly 4%. Employment in all other health care sectors declined during the same time period (Table 117).

Table 117. Number of Health Care Jobs in the Southern Tier Region, by Setting, 2010-2014 Change Between Setting 2010 2011 2012 2013 2014 2010 and 2014 Number Percent Hospitals 12,943 13,319 13,659 13,694 13,396 453 3.5% Ambulatory care 7,703 7,740 7,586 7,591 7,572 -131 -1.7% (excluding home health) Nursing homes and personal 6,901 6,733 6,706 6,665 6,621 -280 -4.1% care facilities Home health care 1,102 1,133 1,131 1,139 1,061 -41 -3.7% Total 28,648 28,925 29,082 29,089 28,650 2 0.0% Source: New York State Department of Labor, ES-202

Employment and Wage by Occupation

Employment for selected health occupations is reported in Table 118. RNs (5,330) held the most jobs in the Southern Tier region, followed by personal care aides (3,930) and nursing assistants (2,960). Physical therapist aides and cardiovascular technologists and technicians held the fewest jobs (60 and 50, respectively).

Wages in selected health occupations for the Southern Tier region are reported in Table 119. These wages were based on 2012-2015 survey data, which were adjusted to include the first quarter of 2016. Pharmacists earned the highest hourly wage in 2016 ($58.53), followed by PAs ($55.29) and medical and health services managers ($51.60). Occupational therapy aides ($12.46) and home health aides ($12.18) were the lowest wage earners among the selected health care occupations in the Southern Tier region.

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Table 118. Number of Jobs in Selected Health Occupations in the Southern Tier Region, 2015 Occupation Employment Registered Nurses 5,330 Personal Care Aides 3,930 Nursing Assistants 2,960 Licensed Practical and Licensed Vocational Nurses 1,770 Home Health Aides 1,690 Social Workers 1,620 Medical and Health Services Managers 530 Pharmacists 480 Pharmacy Technicians 480 Dental Hygienists 450 Medical Assistants 410 Dental Assistants 390 Nurse Practitioners 380 Physical Therapists 380 Radiologic Technologists and Technicians 340 Speech-Language Pathologists 300 Medical Records and Health Information Technicians 270 Occupational Therapists 260 Medical and Clinical Laboratory Technicians 260 Medical and Clinical Laboratory Technologists 220 Medical Secretaries 220 Physician Assistants 210 Respiratory Therapists 170 Mental Health Counselors 160 Surgical Technologists 160 Dietitians and Nutritionists 120 Physical Therapist Assistants 100 Occupational Therapy Assistants 60 Physical Therapist Aides 60 Cardiovascular Technologists and Technicians 50 Source: New York State Department of Labor, Bureau of Labor Statistics, Occupational Wages

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Table 119. Average Hourly Wage in Selected Health Occupations in the Southern Tier Region, 2016 Average Wage Occupation per Hour Pharmacists $58.53 Physician Assistants $55.29 Medical and Health Services Managers $51.60 Nurse Practitioners $45.22 Nuclear Medicine Technologists $37.90 Physical Therapists $35.24 Occupational Therapists $32.14 Respiratory Therapists $31.77 Speech-Language Pathologists $30.79 Medical and Clinical Laboratory Technologists $29.65 Registered Nurses $29.19 Radiologic Technologists and Technicians $28.75 Dietitians and Nutritionists $28.61 Cardiovascular Technologists and Technicians $28.16 Dental Hygienists $28.13 Occupational Therapy Assistants $25.09 Social Workers $24.37 Physical Therapist Assistants $22.93 Medical and Clinical Laboratory Technicians $20.47 Surgical Technologists $20.32 Licensed Practical and Licensed Vocational Nurses $18.88 Mental Health Counselors $18.71 Dental Assistants $17.98 Medical Records and Health Information Technicians $16.73 Dietetic Technicians $16.51 Medical Assistants $15.37 Orderlies $14.77 Medical Secretaries $14.56 Nursing Assistants $13.79 Pharmacy Technicians $13.51 Personal Care Aides $12.87 Physical Therapist Aides $12.60 Occupational Therapy Aides $12.46 Home Health Aides $12.18 Source: New York State Department of Labor, Labor Statistics, Occupational Wages

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Licensed Health Professionals

Between 2010 and 2014, the Southern Tier region experienced the most growth in the number of licensed NPs (nearly 300, or 89%) and RNs (199, or 3%). Physical therapist assistants experienced the largest percentage increase at 332%, followed by clinical laboratory technologists (125%). In contrast, the region experienced declines in the number of dietitians/nutritionists (68%), and occupational therapy assistants (67%) (Table 120).

Table 120. Number of Licensed Individuals in Selected Health Occupations in the Southern Tier Region, 2010-2014 Change Between Profession 2010 2011 2012 2013 2014 2010 and 2014 Number Percent Registered Nurses 7,854 7,874 7,940 8,170 8,053 199 2.5% Licensed Practical Nurses 3,049 3,113 3,107 3,178 3,169 120 3.9% Social Workers 1,299 1,315 1,313 1,373 1,436 137 10.5% Pharmacists 540 546 568 500 546 6 1.1% Physical Therapists 456 461 476 489 494 38 8.3% Nurse Practitioners 338 349 361 623 640 302 89.3% Speech-Language Pathologists 215 206 221 352 347 132 61.4% Clinical Laboratory Technologists 158 158 152 341 355 197 124.7% Physician Assistants 458 463 479 245 264 -194 -42.4% Occupational Therapists 210 227 235 314 322 112 53.3% Dental Hygienists 352 351 350 503 507 155 44.0% Respiratory Therapists 278 284 300 163 166 -112 -40.3% Physical Therapist Assistants 53 51 52 232 229 176 332.1% Dietitians/Nutritionists 473 474 481 149 151 -322 -68.1% Occupational Therapy Assistants 142 139 146 50 47 -95 -66.9% Clinical Laboratory Technicians 102 88 94 93 94 -8 -7.8% Source: New York State Education Department, Office of Professions

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Demand for Health Workers

Hospitals

Hospitals in the Southern Tier reported the most difficulty recruiting experienced RNs, clinical lab technologists, and psychologists. Hospitals in this region indicated they had the most difficulty retaining CNAs, experienced RNs, and newly licensed RNs (Table 121).

Table 121. Recruitment and Retention Difficulties for Hospitals in Selected Health Occupations in the Southern Tier Region, 2016 Percentage of Respondents Average Assessment of Indicating Reasons for Difficulty Difficulties Occupation Shortage Salary Geographic Recruitment Retention of Levels Location Workers Experienced Registered Nurses 4.6 3.5 100% 50% 100% Newly Licensed Registered Nurses 3.8 3.5 90% 40% 100% Nurse Managers 3.7 1.8 100% 50% 100% CNA/Patient Care Techs 3.7 3.6 50% 80% 90% Nurse Practitioners 3.4 3.0 30% 70% 70% Physician Assistants 3.2 3.0 30% 70% 70% Pharmacists 4.0 2.4 30% 70% 40% Clinical Lab Technicians 3.1 2.2 50% 40% 50% Clinical Lab Technologists 4.2 2.6 90% 80% 50% Medical Hospital Coders 3.2 3.3 70% 70% 30% Occupational Therapists 3.1 2.4 50% 30% 50% Care Coordinators 3.2 2.6 40% 40% 40% Case Managers 3.0 2.6 40% 50% 50% Care Managers 2.6 2.7 30% 30% 30% Patient Navigators 3.1 2.6 30% 30% 30% Community Health Workers 2.3 2.6 30% 30% 30% Psychologists 4.1 3.0 40% 40% 80% Psychiatric NPs 3.7 2.9 40% 40% 80% Licensed Clinical Social Workers 3.1 2.6 40% 40% 40% Licensed Master Social Workers 2.9 2.6 50% 40% 50% Licensed Mental Health Counselors 3.6 3.0 40% 40% 40%

• Many hospitals projected growth in inpatient services, with increasing demand for care managers (80%), care coordinators (80%), and NPs (70%). • Many hospitals projected growth in outpatient services, with increasing demand for care managers (80%), RNs (50%), and community health workers (50%).

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Nursing Homes

Nursing homes in the Southern Tier region indicated that experienced RNs were the most difficult to recruit, followed by nurse managers, LPNs, speech-language pathologists, and physical therapists. LPNs, newly licensed RNs, and nurse managers were the most difficult to retain (Table 122).

Table 122. Recruitment and Retention Difficulties for Nursing Homes in Selected Health Occupations in the Southern Tier Region, 2016 Average Assessment of Percentage of Respondents Indicating Difficulty Reasons for Difficulties Occupation Shortage Salary Recruitment Retention of Benefits Location Levels Workers Activities Director 1.8 1.5 0% 0% 17% 0% Certified Nurse Aides/Assts. (CNAs) 3.9 4.1 78% 56% 44% 67% Dietary Aides 2.6 3.0 13% 50% 25% 25% Dietitians/Nutritionists 2.5 2.0 17% 0% 17% 17% Housekeeping Staff 2.7 3.0 22% 22% 11% 44% Licensed Practical Nurses 4.3 4.3 78% 67% 56% 44% Medical Billers 1.8 2.3 0% 0% 0% 25% Occupational Therapists 3.5 3.3 50% 17% 17% 33% Occupational Therapy Assistants 3.4 3.0 40% 0% 20% 40% Physical Therapists 4.2 4.0 67% 17% 17% 50% Physical Therapist Assistants 3.0 3.0 25% 0% 25% 25% Registered Nurses (RNs) Newly Licensed RNs 4.1 4.3 100% 71% 71% 57% Experienced RNs 4.6 4.2 89% 56% 67% 56% MDS Coordinators 3.8 3.8 67% 50% 67% 50% Nurse Manager 4.5 4.3 75% 50% 50% 50% Director of Nursing 3.3 3.3 50% 33% 50% 67% Recreational Therapists 4.0 2.0 0% 50% 0% 100% Respiratory Therapists 3.0 2.0 0% 0% 0% 0% Social Workers (SWs) Licensed Clinical SWs 2.7 1.5 0% 0% 0% 0% Licensed Master SWs 1.8 1.8 0% 0% 17% 0% Speech-Language Pathologists 4.3 3.7 67% 33% 67% 33%

• Sixty-seven percent (67%) of nursing homes reported difficulty hiring part-time workers. • Eighty-nine percent (89%) of nursing homes indicated difficulty hiring workers for off shifts (evenings, nights, and weekends).

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Home Health Care Agencies

Home health care agencies in the Southern Tier region indicated that experienced RNs and licensed clinical social workers were the most difficult to recruit. Homemakers were the most difficult to retain, followed by home health aides and personal care aides (Table 123).

Table 123. Recruitment and Retention Difficulties for Home Health Care Agencies in Selected Health Occupations in the Southern Tier Region, 2016 Average Assessment of Percentage of Respondents Indicating Reasons Difficulty for Difficulties Non- Occupation Lack of Competitive Recruitment Retention Shortage Specialized Location Salaries/ Training Benefits Home Health Aides 3.7 4.5 67% 100% 67% 67% Homemakers 1.0 5.0 0% 200% 0% 100% Personal Care Aides 3.0 4.5 50% 100% 50% 100% Dietitians/Nutritionists 3.0 2.5 0% 0% 0% 0% Licensed Practical Nurses 2.8 3.0 0% 25% 0% 0% Occupational Therapists 3.5 3.0 0% 0% 0% 50% Physical Therapists 4.0 3.0 50% 0% 0% 50% Registered Nurses Newly Licensed RNs 2.5 3.0 50% 100% 100% 0% Experienced RNs 4.8 2.7 75% 50% 0% 50% Respiratory Therapists 4.0 3.0 100% 0% 0% 0% Social Workers (SWs) Licensed Clinical SWs 4.5 3.0 50% 0% 100% 0% Licensed Master SWs 2.7 2.0 0% 0% 33% 0% Speech-Language Pathologists 4.0 3.0 100% 0% 50% 100%

• Twenty percent (20%) of home health care agencies reported difficulty hiring part-time workers. • Twenty percent (20%) of home health care agencies reported difficulty hiring bilingual workers. • Eighty percent (80%) of home health care agencies indicated difficulty hiring workers for off shifts (evenings, nights, and weekends). • The majority of home health agencies in the Southern Tier planned expansion of services within the next year.

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FQHCs FQHCs in the Southern Tier region had the most difficulty recruiting Ob/Gyns, pediatricians, and psychiatric NPs, and psychiatrists. FQHCs in this region had the most difficulty retaining psychiatric NPs, followed by obstetricians/gynecologists and substance abuse counselors (Table 124).

Table 124. Recruitment and Retention Difficulties for FQHCs in Selected Health Occupations in the Southern Tier Region, 2016 Average Assessment of Occupation Difficulty Recruitment Retention Family/General Practice 4.2 2.7 Internal Medicine 4.5 3.0 Physicians Ob/Gyn 5.0 4.0 Pediatricians 5.0 2.0 Physician Assistants (PAs) 2.2 2.4 Overall – All Specialties 2.5 2.8 Pediatric 3.0 2.0 Nurse Practitioners Adult 2.0 3.0 Family 2.5 3.0 Psychiatric 5.0 5.0 Registered Nurses 3.6 2.6 Nurses Licensed Practical Nurses 2.8 3.0 Psychiatrists 5.0 2.0 Psychologists 0.0 0.0 Behavioral Health Substance Abuse Counselors 4.5 4.0 Social Workers 4.0 2.7 Dentists 3.8 3.0 Oral Health Dental Hygienists 2.8 2.3 Care Coordinators 3.7 2.0 Coordination/Patient Case Managers 3.0 2.0 Care HIV Counselors 4.0 3.0 Community Health Workers 2.5 2.0 Patient/Community Patient Health Educators 2.5 2.0 Education Nutritionists/Nutrition Educators 3.5 2.5 Patient Health Navigators 4.0 3.0 Outreach Workers 4.0 3.5 Enabling Services Transportation Workers 3.5 3.0 Interpreters 4.5 2.0 Administrative Support IT Systems Admin/Maintenance 3.3 2.5 Physical Therapists 0.0 0.0 Others Occupational Therapists 0.0 0.0

• Sixty-seven percent (67%) of FQHCs in this region have difficulty hiring bilingual staff; Spanish is the language most needed. • Eighty-three percent (83%) of FQHCs in this region anticipated expanding one or more service.

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Employment Projections by Health Occupation

According to the NYSDOL, the largest numbers of average annual job openings projected in the Southern Tier region between 2012 and 2022 will be for RNs (240), nursing assistants (150), and personal care aides (100) (Table 125).

Table 125. Employment Projections for Selected Health Occupations in the Southern Tier Region, 2012-2022 Change Between Average Occupation 2012 2022 2012 and 2022 Annual Number Percent Openingsa Personal Care Aides 3,180 3,920 740 23.3% 100 Registered Nurses 8,800 9,460 660 7.5% 240 Nursing Assistants 5,010 5,520 510 10.2% 150 Home Health Aides 1,970 2,460 490 24.9% 90 Licensed Practical and Licensed Vocational 1,960 2,190 230 11.7% 70 Social Workers 1,750 1,900 150 8.6% 60 Emergency Medical Technicians and 800 950 150 18.8% 40 Medical Assistants 540 640 100 18.5% 20 Physical Therapists 550 640 90 16.4% 20 Nurse Practitioners 540 630 90 16.7% 20 Radiologic Technologists 760 830 70 9.2% 20 Medical and Health Services Managers 730 790 60 8.2% 30 Physician Assistants 260 310 50 19.2% 20 Occupational Therapists 330 380 50 15.2% 10 Diagnostic Medical Sonographers 140 190 50 35.7% 0 Surgical Technologists 320 370 50 15.6% 10 Medical Records and Health Info Techs 380 430 50 13.2% 10 Speech-Language Pathologists 390 430 40 10.3% 10 Dental Hygienists 430 470 40 9.3% 20 Pharmacy Technicians 530 570 40 7.5% 10 Dental Assistants 660 700 40 6.1% 10 Respiratory Therapists 350 380 30 8.6% 10 Cardiovascular Technologists & Technicians 190 220 30 15.8% 0 Orderlies 300 330 30 10.0% 10 Dietitians and Nutritionists 190 210 20 10.5% 0 Clinical, Counseling, and School Psychologists 410 420 10 2.4% 10 Pharmacists 670 680 10 1.5% 20 Medical and Clinical Laboratory Technologists 370 380 10 2.7% 10 Psychiatric Aides 540 530 -10 -1.9% 10 a Annual openings reflect creation of new positions in the occupation and replacement for those retiring or otherwise leaving the profession.

Source: New York State Department of Labor, Jobs in Demand/Projects, Long-Term Occupation Projections, 2012-2022

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J. Western New York The Western New York region includes the counties of Allegany, Cattaraugus, Chautauqua, Erie, and Niagara.

Population

The population of the Western New York region was less racially and ethnically than New York as a whole. The region had a smaller percentage of people with a bachelor’s degree or higher but a slightly larger portion of the population had a high school diploma or equivalent, or an associate degree compared to the state as a whole (Table 126).

Table 126. Selected Population Characteristics in the Western New York Region, 2010-2014 (5-Year Average) Region Statewide Population Characteristicsa Number Percent Percent Total population 1,397,007 N/A N/A Population under 100% FPL 205,950 14.7% 15.2% Population under 200% FPL 444,669 31.8% 31.7% Population aged birth to 17 years 295,686 21.2% 21.8% Population aged 65 and older 226,939 16.2% 14.1% Population female aged 15 to 44 264,281 18.9% 20.7% Women aged 15 to 19 who had a birth in past 12 mos. 811 0.1% 0.05% Women aged 20 to 34 who had a birth in past 12 mos. 11,823 0.8% 0.8% Women aged 35 to 50 who had a birth in past 12 mos. 3,180 0.2% 0.3% Black/African American, non-Hispanic 138,694 9.9% 14.4% Hispanic/Latino 60,740 4.3% 18.2% Asian/Pacific Islander, non-Hispanic 31,766 2.3% 7.7% American Indian/Native Alaskan, non-Hispanic 9,126 0.7% 0.2% Two or more/other 24,473 1.8% 2.2% Less than high school education 97,816 10.2% 14.6% High school or equivalent 479,200 50.2% 43.2% Associate degree 113,185 11.8% 8.5% Bachelor's degree 147,492 15.4% 19.1% Master's degree or higher 118,133 12.4% 14.6% a Education levels and rates are based on individuals aged 25 years and older. Source: US Census, American Community Survey, 2010-2014 (5-Year Average)

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Health Status

The Western New York region had substantially higher rates of total deaths, including deaths due to heart disease, deaths due to all cancers, and deaths due to diabetes, than the state as a whole or upstate New York. Although the overall birth rate was lower in the Western New York region than in the state overall, the teen birth rate was higher. The rate of infant deaths was also higher in the Western New York region than statewide or in upstate New York. As compared with the state, the region had lower rates of preventable, asthma-related (adult and pediatric), diabetes-related, and respiratory disease-related hospitalizations than the state as a whole (Table 127).

Table 127. Selected Health Indicators in the Western New York Region, 2011-2013 (3-Year Average) Region Statewide Upstate Health Indicator Number Rate Number Rate Number Rate Total deaths, per 100,000 14,484 1,037.9 147,313 753.1 95,944 854.1 Deaths due to heart disease, per 100,000 3,985 285.5 43,448 222.1 26,818 238.7 Deaths due to all cancers, per 100,000 3,275 234.3 35,215 180.7 22,723 202.4 Deaths due to diabetes, per 100,000 433 31.0 3,975 20.3 2,198 19.6 Total births, per 1,000 females aged 15 to 44 14,771 56.0 238,078 59.0 120,237 56.8 Teen births, per 1,000 females aged 15 to 19 1,128 23.9 12,441 19.5 6,806 17.3 Low-birthweight births, as a percent of total births 1,231 8.4 19,006 8.0 9,150 7.6 Late/no prenatal care, as a percent of total births 734 5.2 13,148 5.6 4,845 4.1 Infant deaths, per 1,000 live births 112 7.6 1,179 5.0 667 5.5 Total hospitalizations, per 10,000 164,247 1,176.9 2,398,679 1,226.2 1,312,126 1,168.1 Preventable hospitalizations, per 10,000 18,500 132.6 293,493 150.0 158,173 140.8 Adult asthma hospitalizations, per 10,000 1,016 8.4 24,276 15.9 8,931 10.2 Pediatric asthma hospitalizations, per 10,000 427 13.1 11,340 26.6 3,513 14.2 Diabetes hospitalizations, per 10,000 2,464 17.7 37,847 19.3 17,503 15.6 CLRD hospitalizations, per 10,000 4,543 32.6 71,475 36.5 37,028 33.0 Heart disease hospitalizations, per 10,000 16,203 116.1 212,301 108.5 125,733 111.9 Total ED visits, per 10,000 576,200 4,128.7 7,993,838 4,086.4 4,215,240 3,752.5 Source: New York State Community Health Indicator Reports, 2011-2013 (3- Year Average)

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Primary Care Physicians

There were nearly 1,500 primary care physicians practicing in the Western New York region. Thirty-one percent (31%) were in family or general practice and another 37% were in general internal medicine. There were almost 200 psychiatrists, including child and adolescent psychiatrists, practicing in the Western New York region, or approximately 13.8 per 100,000. Erie County had the highest rate of family, general, and internal medicine (general) providers within the region, with 79.1 per 100,000 population. Allegany County had the lowest rate of providers, with 53.7 per 100,000 (Table 128 and Figure 31).

Table 128. Primary Care Physicians and Psychiatrists in the Western New York Region, by Specialty, 2015 Per 100,000 Specialty Physicians Populationa Family/General Practice 461 33.0 Internal Medicine (General) 548 39.2 Subtotal 1,009 72.2 Geriatrics 15 6.6 Obstetrics/Gynecology 185 69.8 Pediatrics (General) 276 93.4 Primary Care Total 1,485 N/A Psychiatrist 193 13.8 a All rates are per 100,000 total population except the Ob/Gyn rate, which is per 100,000 women aged 15 to 44, the pediatrician rate, which is per 100,000 children aged birth to 17 years, and the geriatrics rate, which is per 100,000 population aged 65 and older. Source: New York State Physician Re-registration Survey

Figure 31. Number of Selected Primary Care Physicians per 100,000 Population in the Western New York Region, by County, 2015

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Employment

Total Health Sector Employment

Between 2010 and 2014, health sector employment throughout the Western New York region decreased by 417 jobs, or 0.6%. Nearly 1,200 jobs (4%) were lost in hospitals between 2010 and 2014, but jobs in home health care increased by 260 jobs, or almost 5.3%, and jobs in ambulatory care increased by over 750 jobs, or 3%. Nursing home and personal care facilities experienced a loss of 250 jobs, or about 2% (Table 129).

Table 129. Number of Health Care Jobs in the Western New York Region, by Setting, 2010-2014 Change Between Setting 2010 2011 2012 2013 2014 2010 and 2014 Number Percent Hospitals 27,348 27,071 26,800 26,717 26,153 -1,195 -4.4% Ambulatory care 23,372 23,640 22,958 23,478 24,140 768 3.3% (excluding home health) Nursing home and personal 15,844 15,644 15,618 15,436 15,594 -250 -1.6% care facilities Home health care 4,892 5,030 5,272 5,333 5,152 260 5.3% Total 71,456 71,384 70,648 70,964 71,039 -417 -0.6% Source: New York State Department of Labor, ES-202

Employment and Wage by Occupation

Employment for selected health occupations is reported in Table 129. RNs (13,300) held the most jobs in in the Western New York region, followed by personal care aides (9,090) and nursing assistants (6,390). Dietetic technicians (90) and occupational therapy aides (50) had the fewest jobs.

Wages in selected health occupations for Western New York are reported in Table 130. These wages were based on 2012-2015 survey data, which were adjusted to include the first quarter of 2016. Certified registered nurse anesthetists earned the highest hourly wage in 2016 ($78.25), followed by pharmacists ($60.82) and medical and health services managers ($51.25). Pharmacy technicians ($13.95), personal care aides ($12.48), and home health aides ($12.34) were the lowest wage earners in the selected health occupations in the Western New York region.

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Table 130. Number of Jobs in Selected Health Occupations in the Western New York Region, 2015 Occupation Employment Registered Nurses 13,300 Personal Care Aides 9,090 Nursing Assistants 6,390 Home Health Aides 5,640 Licensed Practical and Licensed Vocational Nurses 5,090 Social Workers 3,750 Pharmacy Technicians 1,820 Medical Assistants 1,610 Pharmacists 1,540 Medical Secretaries 1,430 Dental Assistants 1,220 Medical and Health Services Managers 1,210 Speech-Language Pathologists 1,200 Dental Hygienists 1,180 Physical Therapists 1,040 Radiologic Technologists and Technicians 980 Medical Records and Health Information Technicians 800 Nurse Practitioners 790 Physician Assistants 700 Occupational Therapists 690 Mental Health Counselors 520 Respiratory Therapists 500 Surgical Technologists 420 Medical and Clinical Laboratory Technologists 410 Medical and Clinical Laboratory Technicians 400 Physical Therapist Assistants 360 Dietitians and Nutritionists 330 Occupational Therapy Assistants 270 Cardiovascular Technologists and Technicians 200 Physical Therapist Aides 140 Nuclear Medicine Technologists 120 Dietetic Technicians 90 Occupational Therapy Aides 50 Source: New York State Department of Labor, Bureau of Labor Statistics, Occupational Wages

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Table 131. Average Hourly Wage in Selected Health Occupations in the Western New York Region, 2016 Average Wage Occupation per Hour Nurse Anesthetists $78.25 Pharmacists $60.82 Medical and Health Services Managers $51.25 Nurse Midwives $47.87 Nurse Practitioners $46.84 Physician Assistants $45.76 Speech-Language Pathologists $36.75 Physical Therapists $35.80 Nuclear Medicine Technologists $34.55 Registered Nurses $33.28 Occupational Therapists $32.04 Respiratory Therapists $28.89 Medical and Clinical Laboratory Technologists $28.38 Dental Hygienists $27.66 Dietitians and Nutritionists $27.38 Radiologic Technologists and Technicians $27.10 Cardiovascular Technologists and Technicians $25.75 Surgical Technologists $24.21 Social Workers $22.90 Physical Therapist Assistants $22.12 Occupational Therapy Assistants $21.31 Medical and Clinical Laboratory Technicians $21.31 Medical Records and Health Information Technicians $20.63 Mental Health Counselors $19.64 Licensed Practical and Licensed Vocational Nurses $19.62 Dental Assistants $17.65 Dietetic Technicians $16.76 Medical Assistants $16.51 Medical Secretaries $16.22 Occupational Therapy Aides $14.59 Physical Therapist Aides $14.48 Nursing Assistants $14.14 Pharmacy Technicians $13.95 Personal Care Aides $12.48 Home Health Aides $12.34 Source: New York State Department of Labor, Labor Statistics, Occupational Wages

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Licensed Health Professionals

Between 2010 and 2014 in the Western New York region, the number of licensed RNs increased by more than 1,000, or nearly 5%, and the number of licensed social workers grew by almost 370, or by nearly 20%. By percentage, PAs grew the fastest in the Western New York region, increasing by 48%, followed by physical therapist assistants (34%), NPs (23%), and social workers (20%). In contrast, occupational therapy assistants experienced declines of 2% (Table 132).

Table 132. Number of Licensed Individuals in Selected Health Occupations in the Western New York Region, 2010-2014 Change Between Profession 2010 2011 2012 2013 2014 2010 and 2014 Number Percent Registered Nurses 18,815 18,876 19,260 19,977 19,831 1,016 5.4% Licensed Practical Nurses 7,041 7,182 7,133 7,188 7,302 261 3.7% Social Workers 1,916 2,038 2,108 2,223 2,290 374 19.5% Pharmacists 1,613 1,651 1,694 1,735 1,887 274 17.0% Physical Therapists 1,267 1,274 1,323 1,383 1,409 142 11.2% Nurse Practitioners 1,164 1,212 1,254 1,351 1,434 270 23.2% Speech-Language Pathologists 1,105 1,146 1,172 1,203 1,207 102 9.2% Clinical Laboratory Technologists 988 983 989 977 984 -4 -0.4% Physician Assistants 622 665 712 802 919 297 47.7% Occupational Therapists 767 786 812 848 877 110 14.3% Dental Hygienists 1,090 1,131 1,138 1,157 1,167 77 7.1% Respiratory Therapists 451 455 480 495 509 58 12.9% Physical Therapist Assistants 322 337 351 393 430 108 33.5% Dietitians/Nutritionists 318 316 337 353 349 31 9.7% Occupational Therapy Assistants 586 602 601 592 572 -14 -2.4% Clinical Laboratory Technicians 192 196 194 188 201 9 4.7% Source: New York State Education Department, Office of Professions

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Demand for Health Workers

Hospitals

Hospitals in the Western New York region reported the most difficulty recruiting clinical laboratory technologists and technicians, and nurse managers. Hospitals in Western New York indicated the most difficulty retaining experienced RNs, newly licensed RNs, and clinical lab technologists (Table 133).

Table 133. Recruitment and Retention Difficulties for Hospitals in Selected Health Occupations in the Western New York Region, 2016 Percentage of Respondents Average Assessment of Indicating Reasons for Difficulty Difficulties Occupation Shortage Salary Geographic Recruitment Retention of Levels Location Workers Experienced Registered Nurses 3.9 4.3 89% 67% 100% Newly Licensed Registered Nurses 2.3 4.0 22% 11% 22% Nurse Managers 4.2 3.0 78% 11% 89% CNA/Patient Care Techs 3.9 3.9 67% 22% 0% Nurse Practitioners 3.9 2.3 67% 0% 78% Physician Assistants 3.9 2.1 78% 67% 89% Pharmacists 2.6 2.0 22% 11% 33% Clinical Lab Technicians 4.4 3.0 78% 0% 11% Clinical Lab Technologists 4.6 4.0 89% 11% 22% Medical Hospital Coders 2.9 2.9 56% 0% 0% Occupational Therapists 2.1 1.9 11% 0% 22% Care Coordinators 2.1 2.0 11% 0% 11% Case Managers 2.0 1.9 11% 0% 11% Care Managers 2.1 2.0 11% 0% 11% Patient Navigators 2.1 2.0 11% 0% 11% Community Health Workers 1.9 1.8 0% 0% 0% Psychologists 2.5 2.0 0% 0% 11% Psychiatric NPs 2.5 2.0 0% 0% 11% Licensed Clinical Social Workers 1.7 1.7 0% 0% 11% Licensed Master Social Workers 1.7 2.0 0% 11% 11% Licensed Mental Health Counselors 3.0 2.0 11% 11% 22%

• Many hospitals projected growth in inpatient services, with increasing demand for NPs (67%), RNs (67%), and CNAs (67%). • Many hospitals projected growth in outpatient services, with increasing demand for CNAs (89%), LPNs (67%), and clinical lab technicians (67%).

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Nursing Homes

Nursing homes in the Western New York region reported the most difficulty recruiting nurse managers, followed by MDS coordinators, LPNs, and experienced RNs. CNAs were the most difficult to retain, followed by dietary aides, LPNs, experienced RNs, and nurse managers (Table 134).

Table 134. Recruitment and Retention Difficulties for Nursing Homes in Selected Health Occupations in the Western New York Region, 2016 Average Assessment of Percentage of Respondents Indicating Difficulty Reasons for Difficulties Occupation Shortage Salary Recruitment Retention of Benefits Location Levels Workers Activities Director 2.3 1.3 14% 0% 0% 14% Certified Nurse Aides/Assts. (CNAs) 3.4 3.8 38% 0% 0% 50% Dietary Aides 2.9 3.6 13% 13% 0% 13% Dietitians/Nutritionists 2.1 1.6 0% 0% 0% 0% Housekeeping Staff 3.0 3.4 25% 0% 0% 13% Licensed Practical Nurses 3.9 3.6 50% 25% 13% 50% Medical Billers 3.0 2.0 17% 0% 0% 17% Occupational Therapists 3.4 2.1 38% 0% 0% 13% Occupational Therapy Assistants 3.0 2.3 38% 0% 0% 25% Physical Therapists 3.1 2.0 25% 0% 0% 13% Physical Therapist Assistants 3.0 2.1 25% 0% 0% 13% Registered Nurses (RNs) Newly Licensed RNs 3.6 3.3 29% 29% 0% 29% Experienced RNs 3.9 3.6 38% 25% 0% 38% MDS Coordinators 4.0 3.0 17% 0% 0% 0% Nurse Manager 4.4 3.6 43% 0% 0% 0% Director of Nursing 3.0 2.3 0% 0% 0% 0% Recreational Therapists 2.7 2.7 0% 0% 0% 0% Respiratory Therapists 2.5 2.5 0% 0% 0% 0% Social Workers (SWs) Licensed Clinical SWs 3.0 2.3 29% 0% 0% 14% Licensed Master SWs 2.8 2.0 20% 0% 0% 20% Speech-Language Pathologists 3.0 2.2 33% 0% 0% 0%

• Thirty-eight percent (38%) of nursing homes reported difficulty hiring part-time workers. • Sixty-three percent (63%) of nursing homes indicated difficulty hiring workers for off shifts (evenings, nights, and weekends).

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Home Health Care Agencies

As a result of low response rates to the employer demand survey, responses from home health care agencies in the Western New York region were combined with responses from home health care agencies in the Finger Lakes region for analysis. Home health care agencies in these combined regions indicated the most difficulty recruiting homemakers and speech-language pathologists. Home health aides were the most difficult to retain, followed by personal care aides, and speech-language pathologists (Table 135).

Table 135. Recruitment and Retention Difficulties for Home Health Care Agencies in Selected Health Occupations in the Finger Lakes and Western New York Regions, 2016 Average Assessment of Percentage of Respondents Indicating Reasons for Difficulty Difficulties Non- Occupation Lack of Competitive Recruitment Retention Shortage Specialized Location Salaries/ Training Benefits Home Health Aides 3.2 3.5 33% 17% 17% 33% Homemakers 5.0 2.0 0% 0% 0% 0% Personal Care Aides 4.0 3.0 0% 0% 0% 50% Dietitians/Nutritionists 3.7 2.3 0% 0% 67% 0% Licensed Practical 1.8 2.0 0% 25% 0% 0% Nurses Occupational 4.0 2.0 0% 100% 0% 0% Therapists Physical Therapists 3.0 2.0 67% 33% 0% 33% Registered Nurses Newly Licensed RNs 2.0 2.0 0% 0% 0% 0% Experienced RNs 3.2 2.8 17% 67% 17% 17% Respiratory Therapists N/A N/A N/A N/A N/A N/A Social Workers (SWs) Licensed Clinical SWs 2.8 2.0 25% 25% 0% 0% Licensed Master SWs 2.8 2.0 50% 17% 0% 0% Speech-Language 5.0 3.0 100% 0% 0% 0% Pathologists

• Seventeen percent (17%) of home health care agencies reported difficulty hiring part-time workers. • Seventeen percent (17%) of home health care agencies reported difficulty hiring bilingual workers. • Fifty percent (50%) of home health care agencies indicated difficulty hiring workers for off shifts (evenings, nights, and weekends). • Two-thirds of the respondents reported plans to expand services within the next year.

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FQHCs FQHCs in the Western New York region had the most difficulty recruiting psychiatrists, followed by psychiatric NPs and internal medicine physicians. FQHCs in this region had the most difficulty retaining psychiatrists, followed by dentists. (Table 136).

Table 136. Recruitment and Retention Difficulties for FQHCs in Selected Health Occupations in the Western New York Region, 2016 Average Assessment of Difficulty Occupation Recruitment Retention Family/General Practice 4.4 3.3 Internal Medicine 4.7 3.5 Physicians Ob/Gyn 4.0 2.0 Pediatricians 4.3 1.5 Physician Assistants (PAs) 2.5 2.4 Overall – All Specialties 3.2 3.0 Pediatric 2.0 1.5 Nurse Practitioners Adult 1.5 1.5 Family 3.3 2.8 Psychiatric 4.8 3.2 Registered Nurses 2.9 2.5 Nurses Licensed Practical Nurses 2.3 2.3 Psychiatrists 5.0 5.0 Psychologists 0.0 0.0 Behavioral Health Substance Abuse Counselors 4.5 3.5 Social Workers 4.2 3.0 Dentists 4.0 4.7 Oral Health Dental Hygienists 3.0 3.3 Care Coordinators 2.4 2.3 Coordination/Patient Case Managers 2.0 2.0 Care HIV Counselors 4.0 3.0 Community Health Workers 1.8 2.0 Patient/Community Patient Health Educators 2.0 2.0 Education Nutritionists/Nutrition Educators 2.5 3.0 Patient Health Navigators 2.0 2.0 Outreach Workers 2.0 1.7 Enabling Services Transportation Workers 2.5 1.5 Interpreters 2.8 1.3 Administrative Support IT Systems Admin/Maintenance 2.0 2.0 Physical Therapists 0.0 0.0 Others Occupational Therapists 0.0 0.0

• Of those FQHCs who responded for this region, all indicated plans of expanding one or more service. • Fifty percent (50%) identified difficulty hiring bilingual staff.

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Employment Projections by Health Occupation

According to the NYSDOL, the largest numbers of average annual job openings projected in the Western New York region between 2012 and 2022 will be for RNs (370), personal care aides (310), and home health aides (250) (Table 137).

Table 137. Employment Projections for Selected Health Occupations in the Western New York Region, 2012-2022 Change Between Average Occupation 2012 2022 2012 and 2022 Annual Number Percent Openingsa Personal Care Aides 9,020 11,550 2,530 28.0% 310 Home Health Aides 5,480 6,990 1,510 27.6% 250 Registered Nurses 13,390 14,450 1,060 7.9% 370 Licensed Practical and Licensed Vocational 5,260 6,210 950 18.1% 220 Nursing Assistants 7,330 8,010 680 9.3% 210 Social Workers 3,570 3,900 330 9.2% 110 Physical Therapists 1,180 1,430 250 21.2% 60 Dental Hygienists 1,100 1,350 250 22.7% 60 Nurse Practitioners 850 1,060 210 24.7% 40 Pharmacy Technicians 1,660 1,870 210 12.7% 40 Medical Assistants 1,070 1,270 200 18.7% 40 Dental Assistants 1,110 1,270 160 14.4% 40 Physician Assistants 440 570 130 29.5% 20 Medical and Health Services Managers 1,420 1,540 120 8.5% 50 Occupational Therapists 680 800 120 17.6% 20 Speech-Language Pathologists 1,090 1,200 110 10.1% 30 Medical Records and Health Info Techs 860 970 110 12.8% 30 Pharmacists 1,420 1,520 100 7.0% 40 Radiologic Technologists 1,090 1,190 100 9.2% 30 Emergency Medical Technicians and 810 910 100 12.3% 30 Diagnostic Medical Sonographers 280 370 90 32.1% 10 Surgical Technologists 340 390 50 14.7% 10 Medical and Clinical Laboratory Technicians 320 360 40 12.5% 20 Dietitians and Nutritionists 340 370 30 8.8% 0 Respiratory Therapists 510 540 30 5.9% 10 Cardiovascular Technologists & Technicians 150 170 20 13.3% 0 Clinical, Counseling, and School Psychologists 760 770 10 1.3% 20 Medical and Clinical Laboratory Technologists 440 450 10 2.3% 10 a Annual openings reflect creation of new positions in the occupation and replacement for those retiring or otherwise leaving the profession. Source: New York State Department of Labor, Jobs in Demand/Projects, Long-Term Occupation Projections, 2012-2022

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